A New Method of Boerhaave Syndrome Surgical Treatment and Its Experimental Justification

Abstract

Relevance. Spontaneous esophageal rupture (Boerhaave syndrome) is observed relatively rare ranging from 2.9% to 12% of all cases of damage of the esophagus. Today, there is not any categorical opinion about the effectiveness of different treatments among surgeons, there are not any single algorithms for the diagnosis and evaluation of treatment. Spontaneous esophageal rupture is a real threat for the life of patient: mortality up to 75% in the prehospital period and more than 90% in the postoperative period, and depends on the time interval between the rupture of the esophageal wall and the operation time, and also complications (suppurative esophagitis, suppurative mediastinitis, bilateral suppurative lobular pneumonia, sepsis). Purpose. To improve results of surgical treatment of patients with spontaneous esophageal rupture using the results obtained in the experiment. Materials and methods. Since 2004 till 2017 twelve patients with spontaneous esophageal rupture were treated in our hospital. Ways of treatment of lower third of esophageal rupture: drainage of pleural cavity – 2 patients; closure of the defect, fundoplication with covered stitches by the bottom of the stomach – 2 patients; perforated hole was not sutured, and a cuff, covering the perforation, was formed from the bottom of the stomach (fundoplication by Chernousov) – 8 patients. These methods of surgical treatment were applied in the experiments on 120 rats. Each group consisted of 40 rats. Results and discussion. The pleural cavity drainage, lethality – 1 (50%) patient. The suturing of the defect of the esophageal walls, the fundoplication with the stitches, covered by the bottom of the stomach, failure of stitches – 2 patients, lethality – 1 (50%) patients. The perforated hole was not sutured, and the cuff was shaped from the bottom of the stomach, covering the perforation. Lethality – 2 (25%) patients, caused by bilateral pneumonia in contrast to progressive sepsis. Other patients operated on this method didn’t have any failure of stiches. In the experiment: in the 1st group the failure of stitches was 87.5% and lethality – 100%; in the 2nd group the failure of stitches was 85% and lethality – 100%; in the 3rd group  there was not any failure of stitches, lethality – 17.5%. Conclusions. The most effective method of treatment is the restoration of rupture esophagus without suturing, and forming a cuff from the bottom of the stomach, covering the perforation. Drainage of pleural cavity and nutrition through a nasogastric tube.