Experience with the Grillo Pleural Wrap Procedure in 18 Patients with Perforation of the Thoracic Esophagus

Abstract

Perforation of the thoracic esophagus may be fatal unless diagnosed promptly and treated with an effective operation. The wide mortality range in different reports reflects the importance of these two factors. This range spans from as low as 11%, if operation is within 24 hours, to greater than 50% after two to three days. The high mortality with delayed treatment is principally due to inability to surgically close the perforation. Eighteen patients (aged from 31 to 78 years) were treated four hours to 14 days after thoracic esophageal perforation (less than 24 hours: 7 patients; 24 to 72 hours: 7 patients; greater than 72 hours: 4 patients). In 14 patients the perforation was sutured, after which the suture line was buttressed with a circumferential wrap of parietal pleura, originally described by Grillo. Underlying esophageal pathology was corrected and wide mediastinal drainage was instituted. All 14 patients recovered and were discharged from the hospital after a median stay of 20 days. Two patients had minor leaks at the suture line that soon closed. Four patients had perforations too extensive to close. Of these, one was resected, the Urschel procedure was used in two, and the Abbott T-tube drainage was used in one. Three of the four patients died. It was quite significant that the pleural wrap was equally effective with both early (6 patients) and delayed perforations (8 patients). These data indicate that the pleural wrap should be used routinely. Extensive perforations that cannot be closed should probably be treated by resection and drainage, followed by esophageal reconstruction at a later time.

Treatment of perforation in the healthy esophagus: analysis of 12 cases

“…The onset of the signs and symptoms of a perforation depends on its cause, the site involved, the time elapsing before diagnosis, and the preferential route of contamination. Chest pain is the most frequent symptom of presentation, as already described in other series [16]: Of the patients, 70-90% (83.33% in our series) refer chest pain, which usually correlates with the site of the perforation [17]. Dysphagia and dyspnea are the other, less frequently reported symptoms.…”

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

“…[2][3][4][5][6][7][8] Surgical treatment has long been the 'gold standard' for these emergencies. 1,5,[9][10][11][12] Over the past few years, new minimally invasive endoscopic treatment options have emerged, i.e. closure with clips or sutures, sealing with biological glue and sealing with stent placement.…”

Uso de colgajos musculares en las perforaciones traumáticas del esófago

“…Por esta razón algunos autores proponen individualizar el tratamiento de los pacientes en estas condiciones 5,8 . La sutura primaria con la realización de algún tipo de colgajo para reforzarla es una de las técnicas que ha tenido mejores resultados en los últimos años y es recomendada como tratamiento de elección en cualquier tipo de perforación por varios autores 7,9,10 . En nuestro primer caso, el esófago fue reparado con puntos separados en un solo plano y la línea de sutura se reforzó con músculo esternocleidoFigura 5.…”