Oesophageal perforation: Primary suture repair reinforced with absorbable mesh and fibrin glue

Abstract

Despite major advances in the management of intrathoracic oesophageal perforation, morbidity and mortality rates remain Currently accepted management3 includes early thoracotomy, cleansing of the mediastinum, oesophageal suture and pleural space drainage. Even when performed at an early stage, primary oesophageal suture repair remains precarious, however. Experience of oesophageal primary suture reinforced with absorbable mesh and fibrin glue is reported. Surgical techniqueBetween June 1990 and December 1991, five patients with intrathoracic oesophageal perforation were treated with this technique. The mean age of patients was 59 (range 4379) years. Two iatrogenic perforations resulted from endoscopy (foreign-body extraction, balloon dilatation for achalasia), one from forceful vomiting, one from barotrauma and one from direct injury (chicken bone).Two patients were operated on within 24 h and the other three within 48 h. A transthoracic approach was used. The oesophagus was dissected from its bed in the a m of the perforation. The oesophageal muscular wound was widened to expose the whole length of the mucosal rupture. Healthy mucosa was sutured with 5/0 silk or polydioxanone. In the patient with achalasia an absorbable polyglactin mesh was shaped to fit the sue of the muscular edges. Biological glue (Tissucol; Immuno, Brussels, Belgium) was applied over the prosthetic flap and around the neighbouring oesophagus (Fig. la). Thereafter a Heller procedure was performed. In the other four patients the muscle layer was approximated, an absorbable mesh was wrapped and sutured around half the circumference of the oesophagus (to cover the repair) and the glue was applied thereafter (Fig. Ib). The chest was drained. A feeding jejunostomy was created and a nasogastric suction tube placed to minimize gastro-oesophageal reflux. Antibiotics were given in each case. Oral feeding was started once radiological studies had confirmed oesophageal healing.

Boerhaave's syndrome: 10 years experience and review of the literature

“…Various surgical techniques to repair the oesophageal defect have been described in the literature including primary repair, reinforced primary closure with either tissue or mesh, mediastinal drainage alone, T‐tube drainage, exclusion and diversion as well as intraluminal stenting and resection 2,5−10 . Primary repair has been performed thorascopically but has been restricted to the management of iatrogenic perforation recognized early 11 .…”

New Approach to Surgical Management of Early Esophageal Thoracic Perforation: Primary Suture Repair Reinforced with Absorbable Mesh and Fibrin Glue

“…The authors note that an abbreviated report of this technique has been previously published [25]. Some, but not all, of the patients in this paper were described in that previous short report.…”

Successful Surgical Treatment of a Spontaneous Rupture of the Esophagus Diagnosed Two Days after Onset

“…In the present case, we could select primary closure more than 24 h after onset because the patient was young, his general state was stable, there was no evidence of clinical sepsis, the esophageal tissue was repairable, and the wound edges were viable without necrosis. And more importantly, we could select patching with elevated great omentum as the repair method regardless of various surgical techniques to reinforce primary closure with either tissue or mesh or pericardial fat [12, 13] because great omentum is rich in blood flow and resists wound infection. An esophagogram revealed no extravasation and there was no postoperative leakage.…”