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Evaluation of urgent esophagectomy in esophageal perforation

BACKGROUND: Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinica...

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Autores principales: de AQUINO, José Luis Braga, de CAMARGO, José Gonzaga Teixeira, CECCHINO, Gustavo Nardini, PEREIRA, Douglas Alexandre Rizzanti, BENTO, Caroline Agnelli, LEANDRO-MERHI, Vânia Aparecida
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Colégio Brasileiro de Cirurgia Digestiva 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743215/
https://www.ncbi.nlm.nih.gov/pubmed/25626932
http://dx.doi.org/10.1590/S0102-67202014000400005
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author de AQUINO, José Luis Braga
de CAMARGO, José Gonzaga Teixeira
CECCHINO, Gustavo Nardini
PEREIRA, Douglas Alexandre Rizzanti
BENTO, Caroline Agnelli
LEANDRO-MERHI, Vânia Aparecida
author_facet de AQUINO, José Luis Braga
de CAMARGO, José Gonzaga Teixeira
CECCHINO, Gustavo Nardini
PEREIRA, Douglas Alexandre Rizzanti
BENTO, Caroline Agnelli
LEANDRO-MERHI, Vânia Aparecida
author_sort de AQUINO, José Luis Braga
collection PubMed
description BACKGROUND: Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. AIM: To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. METHODS: A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. RESULTS: Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. CONCLUSIONS: Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures.
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spelling pubmed-47432152016-02-24 Evaluation of urgent esophagectomy in esophageal perforation de AQUINO, José Luis Braga de CAMARGO, José Gonzaga Teixeira CECCHINO, Gustavo Nardini PEREIRA, Douglas Alexandre Rizzanti BENTO, Caroline Agnelli LEANDRO-MERHI, Vânia Aparecida Arq Bras Cir Dig Original Article BACKGROUND: Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. AIM: To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. METHODS: A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. RESULTS: Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. CONCLUSIONS: Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures. Colégio Brasileiro de Cirurgia Digestiva 2014 /pmc/articles/PMC4743215/ /pubmed/25626932 http://dx.doi.org/10.1590/S0102-67202014000400005 Text en http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
de AQUINO, José Luis Braga
de CAMARGO, José Gonzaga Teixeira
CECCHINO, Gustavo Nardini
PEREIRA, Douglas Alexandre Rizzanti
BENTO, Caroline Agnelli
LEANDRO-MERHI, Vânia Aparecida
Evaluation of urgent esophagectomy in esophageal perforation
title Evaluation of urgent esophagectomy in esophageal perforation
title_full Evaluation of urgent esophagectomy in esophageal perforation
title_fullStr Evaluation of urgent esophagectomy in esophageal perforation
title_full_unstemmed Evaluation of urgent esophagectomy in esophageal perforation
title_short Evaluation of urgent esophagectomy in esophageal perforation
title_sort evaluation of urgent esophagectomy in esophageal perforation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743215/
https://www.ncbi.nlm.nih.gov/pubmed/25626932
http://dx.doi.org/10.1590/S0102-67202014000400005
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