Reinforced Primary repair of Early Distal Oesophageal Perforation

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Abstract
To describe our surgical technique for, and results of, reinforced primary repair in benign distal oesophageal perforation in early cases. Retrospective study. Tertiary care hospital, Kuwait. 15 patients with iatrogenic or traumatic benign distal oesophageal perforation. Primary repair with reinforcement using pleura, pericardial flap, or gastric fundus. Of the 3 patients with achalasia, 2 had oesophagomyotomy alone and 1 had oesophagomyotomy with fundoplication. Associated distal obstruction caused by reflux stricture was treated by dilatation and fundoplication in 1 patient. The causes of perforation, presence of underlying oesophageal disease, time to operation, postoperative leakage, mortality, and follow-up. Perforation was caused by instrumentation in 10 patients, trauma in 3, and ingested foreign bodies in 2. 6 patients had pre-existing oesophageal diseases: achalasia in 3, hiatus hernia in 2, and reflux stricture in 1. 10 patients presented within 12 hours, and 5 patients more than 12 hours after the perforation. 4 postoperative leaks developed. One patient perforated a stress gastric ulcer and then developed pneumonia and died of multiple organ failure. At follow-up, all 14 surviving patients were able to eat a normal diet. 2 patients who had gastric fundus used as a reinforcement tissue developed mild gastro-oesophageal reflux and oesophagitis. Both responded to medical treatment. Primary repair and tissue reinforcement of benign distal oesophageal perforation is safe in early cases and obviates the need for a second operation.

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