Primary closure of a spontaneous esophageal rupture under hand-assisted laparoscopy: a case report

Abstract

Spontaneous rupture of the esophagus, which is also known as Boerhaave’s syndrome, is a rare life-threatening condition that requires urgent surgical management. The optimal treatment involves surgical repair of the esophageal defect, which is usually accomplished via laparotomy, thoracotomy, or both, and mediastinal debridement. Here, we report a case of spontaneous rupture of the esophagus that was treated with suturing repair and drain insertion using a hand-assisted laparoscopic approach.

Trans-hiatal repair for Oesophageal and Junctional perforation: a case series

“…Septic patients should be resuscitated and optimised with antibiotics prior to surgery [9]. It should generally be utilised where contamination is localised within the mediastinum, as removal of contaminants may not be sufficient otherwise [10]. In the presence of a mediastinal abscess, percutaneous drainage can be utilised as an adjunct, having demonstrated high success rates without the need for re-intervention in up to 96% of patients [11,12].…”

“…However, this approach does not allow for reinforcement of the suture line with an omental patch -this would require re-positioning and abdominal access [14]. Its use is limited to small tears, about 2-3 cm in diameter [10].…”

“…In contrast, laparoscopic repair for oesophageal perforation is less well described in the literature. Published case reports have reported successful management of oesophageal perforation via laparoscopy, with benefits that outweigh that of thoracoscopy or endoscopy [4,9,10,[18][19][20].…”

“…In cases where suturing is considered unsafe, a fundic patch with a posterior fundoplication has been used to cover the tear to protect the mucosal breach from physiological reflux [20]. The laparoscopic approach also allows for drain placement in the posterior mediastinum and for assessment of the intra-abdominal extent of the injury [9,10]. It is noted that pleural effusions cannot be washed out with this approach.…”

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

“…Mikami et al performed a hand-assisted laparoscopy in a patient with perforation localized in the mediastinum, performed simple closure of the perforation, and inserted drains. The patient’s postoperative course was uneventful, and he was discharged on week 3 after the procedure [17]. Kimberley et al inserted drains into the left pleural cavity in addition to transperitoneal drain insertion, as well as suture closure laparoscopically.…”