Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report

Abstract

BackgroundSpontaneous esophageal rupture is a rare but serious disease with high mortality. Conservative treatment and endoscopic therapy have been reported, but surgical treatment is still a basic modality of therapy. In addition to thoracotomy, recent studies have reported treatment with thoracoscopic surgery and laparoscopic transhiatal repair. In this study, we report a patient who underwent laparoscopic transhiatal suture closure for spontaneous esophageal rupture with favorable postoperative course. We also discuss indication for laparoscopic surgery for spontaneous esophageal rupture.Case presentationA 70-year-old man visited our hospital with chief complaints of epigastric pain and vomitus niger. He was diagnosed with spontaneous esophageal rupture in the left wall of the lower esophagus by computed tomography and upper gastrointestinal (GI) series. At 11 h after the onset of symptoms, we performed laparoscopic transhiatal suture closure and lavage drainage. We performed transhiatal esophageal replacement using the 5-hole approach. We observed a perforation of 2 cm in diameter at the site of the rostral portion approximately 4 cm from the esophageal hiatus. All layers were closed with three stitches using 3–0 absorbable sutures. No perforation was observed in the thoracic cavity. The total operative time was 178 min, and total bleeding was 2 ml. He had no postoperative complications and was discharged on day 15 after the procedure. He received continuous proton pump inhibitor therapy as an outpatient. Healing cicatrization was found at the site of rupture by esophagogastroscopy. The patient was advised to improve his lifestyle and has shown no signs of recurrence over 2 years from the date of surgery.ConclusionsSimple closure of all the layers using laparoscopic transhiatal simple closure was useful in the treatment of esophageal rupture as a less invasive approach for patients who meet the following conditions: stable general condition, intrathoracic perforation, and the perforation site is identified as the lower esophagus by pre-operative examination.

Three Cases of Boerhaave’s Syndrome Treated via Laparoscopic Transhiatal Esophageal Repair

“…Two patients followed a good postoperative course, but 1 patient subsequently succumbed to multi-organ failure. Since then, Kimberley et al [ 6 ], Yeo et al [ 7 ], Hayakawa et al [ 8 ], and Aiolfi et al [ 9 ] have reported a total of 5 cases of Boerhaave's syndrome repaired by only laparoscopic surgery via the transhiatal route. There were no reports of mortality, and good postoperative results were obtained, except for the early case of Landen and El Nakadi [ 5 ] (Table 1 ) [ 6 , 7 , 8 , 9 ].…”

“…Since then, Kimberley et al [ 6 ], Yeo et al [ 7 ], Hayakawa et al [ 8 ], and Aiolfi et al [ 9 ] have reported a total of 5 cases of Boerhaave's syndrome repaired by only laparoscopic surgery via the transhiatal route. There were no reports of mortality, and good postoperative results were obtained, except for the early case of Landen and El Nakadi [ 5 ] (Table 1 ) [ 6 , 7 , 8 , 9 ]. When performing the laparoscopic esophageal repair via the transhiatal route, avoiding penetrating the pleura is vital as it is important not to spread the inflammation in the thoracic cavity.…”

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

“…Which is the best way to approach BS is still a matter of debate: actual guidelines for thoracic esophageal perforation suggest an individualized approach to primary repair the tear, while for what concern specifically esophageal spontaneous rupture, most of the available studies considered the thoracotomy/thoracoscopic approach as the way of choice [9,[17][18][19][20][21]. Anyway, there is not any specific guidelines for BS: some case reports suggest that laparoscopy may be just as safe and effective [12,13]; lastly, some authors also reported conservative or endoscopic treatment: nevertheless, these are just a few studies involving patients with less severe clinical picture, so further researches are needed to better understand their feasibility in more challenging conditions [5,7]. In this case series, we present our 5 years' experience: in all patients, we choose to approach laparoscopically the esophageal tear; when necessary, afterwards we performed a thoracic lavage through left thoracotomy.…”

“…As regards the type of surgical approach, thoracotomy is the most frequently chosen approach even if in literature there are several studies reporting transhiatal management as much as safe [11][12][13]. In our department, transabdominal approach is routinely adopted to treat BS.…”

Suitable Diagnosis and Treatment of Esophageal Ruptures in Cases of Non-Boerhaave Syndrome: A Comparison With Boerhaave Syndrome

“… 1 , 2 Open surgical closure with suturing by thoracotomy or laparotomy is the gold standard in the treatment of esophageal perforation, although recent reports describe using laparoscopy and thoracoscopy. 3 , 4 Esophageal stents and polyglycolic acid sheets in upper gastrointestinal endoscopy are some of the treatments reported to have been attempted for patients with perforations because there are no established treatments. 5 , 6 Patients with esophageal perforation frequently experience Boerhaave syndrome (BS), which is an acute-onset condition with vomiting symptoms as the trigger; these patients frequently present with chest pain as the primary complaint.…”