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Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report.
Surg Case Rep. 2019 Oct 22; 5(1):149.SC

Abstract

BACKGROUND

Spontaneous esophageal rupture is a rare but serious disease with high mortality. Conservative treatment and endoscopic therapy have been reported, but surgical treatment is still a basic modality of therapy. In addition to thoracotomy, recent studies have reported treatment with thoracoscopic surgery and laparoscopic transhiatal repair. In this study, we report a patient who underwent laparoscopic transhiatal suture closure for spontaneous esophageal rupture with favorable postoperative course. We also discuss indication for laparoscopic surgery for spontaneous esophageal rupture.

CASE PRESENTATION

A 70-year-old man visited our hospital with chief complaints of epigastric pain and vomitus niger. He was diagnosed with spontaneous esophageal rupture in the left wall of the lower esophagus by computed tomography and upper gastrointestinal (GI) series. At 11 h after the onset of symptoms, we performed laparoscopic transhiatal suture closure and lavage drainage. We performed transhiatal esophageal replacement using the 5-hole approach. We observed a perforation of 2 cm in diameter at the site of the rostral portion approximately 4 cm from the esophageal hiatus. All layers were closed with three stitches using 3-0 absorbable sutures. No perforation was observed in the thoracic cavity. The total operative time was 178 min, and total bleeding was 2 ml. He had no postoperative complications and was discharged on day 15 after the procedure. He received continuous proton pump inhibitor therapy as an outpatient. Healing cicatrization was found at the site of rupture by esophagogastroscopy. The patient was advised to improve his lifestyle and has shown no signs of recurrence over 2 years from the date of surgery.

CONCLUSIONS

Simple closure of all the layers using laparoscopic transhiatal simple closure was useful in the treatment of esophageal rupture as a less invasive approach for patients who meet the following conditions: stable general condition, intrathoracic perforation, and the perforation site is identified as the lower esophagus by pre-operative examination.

Authors+Show Affiliations

Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan. hayakawa0806@yahoo.co.jp.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.Department of General surgery, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-Ku, Nagoya, 462-8508, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31641962

Citation

Hayakawa, Shunsuke, et al. "Laparoscopic Transhiatal Suture Closure for Spontaneous Esophageal Rupture: a Case Report." Surgical Case Reports, vol. 5, no. 1, 2019, p. 149.
Hayakawa S, Mitsui A, Kato Y, et al. Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report. Surg Case Rep. 2019;5(1):149.
Hayakawa, S., Mitsui, A., Kato, Y., Morimoto, S., Watanabe, K., Shamoto, T., Wakasugi, T., & Kuwabara, Y. (2019). Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report. Surgical Case Reports, 5(1), 149. https://doi.org/10.1186/s40792-019-0711-9
Hayakawa S, et al. Laparoscopic Transhiatal Suture Closure for Spontaneous Esophageal Rupture: a Case Report. Surg Case Rep. 2019 Oct 22;5(1):149. PubMed PMID: 31641962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic transhiatal suture closure for spontaneous esophageal rupture: a case report. AU - Hayakawa,Shunsuke, AU - Mitsui,Akira, AU - Kato,Yuko, AU - Morimoto,Shota, AU - Watanabe,Kaori, AU - Shamoto,Tomonari, AU - Wakasugi,Takehiro, AU - Kuwabara,Yoshiyuki, Y1 - 2019/10/22/ PY - 2019/06/14/received PY - 2019/09/27/accepted PY - 2019/10/24/entrez PY - 2019/10/24/pubmed PY - 2019/10/24/medline KW - Boerhaave’s syndrome KW - Conservative treatment KW - Emergency surgery KW - Esophagus KW - Laparoscopy KW - Spontaneous esophageal rupture KW - Suture closure KW - Thoracoscopic surgery KW - Thoracotomy KW - Transhiatal approach SP - 149 EP - 149 JF - Surgical case reports JO - Surg Case Rep VL - 5 IS - 1 N2 - BACKGROUND: Spontaneous esophageal rupture is a rare but serious disease with high mortality. Conservative treatment and endoscopic therapy have been reported, but surgical treatment is still a basic modality of therapy. In addition to thoracotomy, recent studies have reported treatment with thoracoscopic surgery and laparoscopic transhiatal repair. In this study, we report a patient who underwent laparoscopic transhiatal suture closure for spontaneous esophageal rupture with favorable postoperative course. We also discuss indication for laparoscopic surgery for spontaneous esophageal rupture. CASE PRESENTATION: A 70-year-old man visited our hospital with chief complaints of epigastric pain and vomitus niger. He was diagnosed with spontaneous esophageal rupture in the left wall of the lower esophagus by computed tomography and upper gastrointestinal (GI) series. At 11 h after the onset of symptoms, we performed laparoscopic transhiatal suture closure and lavage drainage. We performed transhiatal esophageal replacement using the 5-hole approach. We observed a perforation of 2 cm in diameter at the site of the rostral portion approximately 4 cm from the esophageal hiatus. All layers were closed with three stitches using 3-0 absorbable sutures. No perforation was observed in the thoracic cavity. The total operative time was 178 min, and total bleeding was 2 ml. He had no postoperative complications and was discharged on day 15 after the procedure. He received continuous proton pump inhibitor therapy as an outpatient. Healing cicatrization was found at the site of rupture by esophagogastroscopy. The patient was advised to improve his lifestyle and has shown no signs of recurrence over 2 years from the date of surgery. CONCLUSIONS: Simple closure of all the layers using laparoscopic transhiatal simple closure was useful in the treatment of esophageal rupture as a less invasive approach for patients who meet the following conditions: stable general condition, intrathoracic perforation, and the perforation site is identified as the lower esophagus by pre-operative examination. SN - 2198-7793 UR - https://www.unboundmedicine.com/medline/citation/31641962/Laparoscopic_transhiatal_suture_closure_for_spontaneous_esophageal_rupture:_a_case_report_ L2 - https://dx.doi.org/10.1186/s40792-019-0711-9 DB - PRIME DP - Unbound Medicine ER -
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