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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Colégio Brasileiro de Cirurgia Digestiva
2014
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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. |
format | Online Article Text |
id | pubmed-4743215 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Colégio Brasileiro de Cirurgia Digestiva |
record_format | MEDLINE/PubMed |
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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