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Minimally invasive surgical management of Boerhaave's syndrome: a narrative literature review.

ABSTRACT: Treatment of Boerhaave's syndrome is controversial. Formal thoracotomy and laparotomy were considered the gold standard treatment in the past. However, these approaches are associated with significant surgical trauma, stress, and postoperative pain. Recently published studies reported the application of minimally invasive surgery in the setting of such esophageal emergency. However, the application of minimally invasive surgery in the setting of Boerhaave's syndrome is debated and evidence is puzzled. The aim of this study was to summarize the current knowledge on minimally invasive treatment of Boerhaave's syndrome. PubMed, EMBASE, and Web of Science databases were consulted. All articles that described the management of Boerhaave's syndrome in the setting of minimally invasive surgery (thoracoscopy or laparoscopy) were included. Sixteen studies and forty-eight patients were included. The age of the patient population ranged from 37 to 81 years old and 74% were males. The time shift period from symptoms onset to surgical treatment ranged from 5 to 240 hours with 10 patients (20.8%) having surgery more than 24 hours from symptoms onset. Vomiting (100%), chest/epigastric pain (88%), and dyspnea (62%) were the most commonly reported symptoms. The perforation size ranged from 6 to 30 mm with 96% of patients suffering from distal esophageal tear. Video-assisted thoracoscopy (VATS) was the most commonly reported surgical approach (75%), followed by laparoscopy (16.7%), and combined thoraco-laparoscopy (6.2%). In case of VATS, a left approach was adopted in 91% of patients with selective lung ventilation. Primary suture was the most commonly performed surgical procedure (60%) with interrupted single or dual-layer repair. Surgical debridement (25%), primary repair reinforced with gastric or omental patch (8%), esophageal repair over T-tube (6%), and endoscopic stenting combined with laparoscopic debridement (2%) were also reported. The postoperative morbidity was 64.5% with pneumonia (42%), pleural empyema (26%), and leak (19%) being the most commonly reported complications. The overall mortality was 8.3%. Boerhaave's syndrome is a rare entity. Minimally invasive surgical treatment seems promising, feasible, and safe in selected patients with early presentation and stable vital signs managed in referral centers. In the management algorithm of Boerhaave's syndrome, a definitive indication to adopt minimally invasive surgery is lacking and its potential role mandates further analysis.

SUBMITTER: Aiolfi A

PROVIDER: S-EPMC7475560 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Minimally invasive surgical management of Boerhaave's syndrome: a narrative literature review.

Aiolfi Alberto A Micheletto Giancarlo G Guerrazzi Guglielmo G Bonitta Gianluca G Campanelli Giampiero G Bona Davide D

Journal of thoracic disease 20200801 8

Treatment of Boerhaave's syndrome is controversial. Formal thoracotomy and laparotomy were considered the gold standard treatment in the past. However, these approaches are associated with significant surgical trauma, stress, and postoperative pain. Recently published studies reported the application of minimally invasive surgery in the setting of such esophageal emergency. However, the application of minimally invasive surgery in the setting of Boerhaave's syndrome is debated and evidence is pu ...[more]

PMID: 32944354

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Project description:Background and Objective The increasingly widespread application of computed tomography (CT) in the screening and follow-up of patients with lung disease has concomitantly increased the detection rate of pulmonary nodules. Currently, minimally invasive thoracic surgery (MITS) has become the preferred method of surgery for patients with pulmonary ground-glass nodules (GGNs) due to its advantages minimal invasiveness and rapid recovery. However, target nodule identification during MITS is sometimes challenging due to the inherent characteristics of these nodules, especially when they are small and distant from the pleura. This review details the many methods used for the intraoperative localization of pulmonary nodules. Methods Literature published in the Cochrane Library, PubMed, ClinicalTrials, and China National Knowledge Infrastructure from 1990 to 2022 were searched and analyzed to obtain a comprehensive review of the different methods of identifying pulmonary nodules. Literature related to animal testing were excluded. Key Content and Findings An overview of the recent progress in the clinical methods for intraoperative localization of pulmonary nodules [including CT-guided percutaneous placement of markers; bronchoscopy-guided placement of markers; intraoperative ultrasonography; three-dimensional (3D) printing technology; artificial intelligence (AI); and intraoperative molecular imaging (IMI)] was conducted. The advantages and disadvantages, as well as the complications associated with existing research methods, were summarized to assist doctors in the development of optimized clinical strategies. Conclusions Clinicians can communicate with the multidisciplinary team and select the appropriate positioning method according to each patient’s individual situation and the available support of the equipment and technology of the institution. Certain non-invasive and specific identification methods may have clinical potential in pulmonary nodule localization in the future.

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Minimally invasive surgical management of Boerhaave's syndrome: a narrative literature review.

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Minimally invasive surgical management of Boerhaave's syndrome: a narrative literature review.

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