Conservative treatment may be sufficient in small intramediastinal (documented) spontaneous ruptures. Recovery even after primary closure of these ruptures within 24 h has been found uncertain by many authors. The patch procedures with well-vascularized diaphragmatic flap or gastric fundus ensure a more secure healing of the primaiy suture repair than other (pleural, intercostal muscle) applied flaps. If the transthoracic primary closure is contraindicated—as in our case with a right-side rupture […]
Once the diagnosis of esophageal leak is made, the most critical decision is the choice of the most appropriate management. Large comparative or international studies of the current surgical techniques could not validate their real value in instances of esophageal disruption. On the contrary, […]
Perforated Healthy Esophagus
The following treatment was adopted in case of mostly instrumental perforations of the healthy esophagus (Table 6). Nonoperative assessment was used in two early small cervical perforations and collar mediastinotomy in two subsequent upper mediastinal abscesses. In case of lower third mediastinal lesions (24 to 48 h), the suture was covered either with a diaphragmatic (Fig 3) or with a modified, better vascularized, vertical fashioned, pleural […]
The poor results following conventional treatment of esophageal disruptions—including even primary closure without reinforcement—incited us 15 years ago to introduce a multimodality assessment in this major surgical emergency.
The value of this more selective management of six spontaneous ruptures and 34 mostly intrathoracic (87.5%) esophageal perforations is evaluated in this retrospective study. […]
Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.