RT Book, Section
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
SR Print(0)
ID 1170407131
T1 Techniques and Indications for Esophageal Exclusion
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170407131
RD 2024/04/24
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.