TY - CHAP M1 - Book, Section TI - Techniques and Indications for Esophageal Exclusion A1 - Paul, Subroto A1 - Zellos, Lambros A2 - Sugarbaker, David J. A2 - Bueno, Raphael A2 - Burt, Bryan M. A2 - Groth, Shawn S. A2 - Loor, Gabriel A2 - Wolf, Andrea S. A2 - Williams, Marcia A2 - Adams, Ann Y1 - 2020 N1 - T2 - Sugarbaker’s Adult Chest Surgery, 3e AB - The four main causes of esophageal perforation are spontaneous perforation associated with protracted vomiting, also known as Boerhaave syndrome; iatrogenic injury from instrumentation; breakdown of esophageal reconstructions after esophagectomy; and penetrating trauma.1–4 Regardless of the etiology, mediastinal contamination from salivary, gastric, and biliary secretions, with the associated bacteria, leads to both local and systemic inflammatory responses. If the perforation is not controlled promptly, it will give rise to sepsis, which if left untreated will result in mortality within 1 week.1,4,5 Despite advances in surgical technique and critical care over the past decades, esophageal perforation remains a challenging clinical problem. Early diagnosis and prompt surgical treatment are the hallmarks of successful outcome after spontaneous (i.e., Boerhaave syndrome) and iatrogenic esophageal perforation. Advocates for primary esophageal repair, drainage with a T-tube, esophageal exclusion, esophageal diversion, and esophagectomy with upfront reconstruction for perforations can be found. Recent developments include endoscopic interventions including stenting, suturing, or vacuum-assisted closure (VAC) therapy.6–9 The trend has been to preserve esophageal continuity if possible. This goal, although optimal, is not always feasible. This chapter describes the techniques and indications for esophageal exclusion. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1170407131 ER -