The clinical presentation of Boerhaave’s syndrome (BS), a rare condition of the gastrointestinal tract characterized by a spontaneous rupture of the esophagus most often caused by vomiting after excessive alcohol drinking or after consuming a large meal, mimics other less serious illnesses, often leading to a missed or delayed diagnosis. The Mackler triad, which is rare and pathognomonic of BS, includes lower thoracic or chest pain, subcutaneous emphysema, and vomiting. Diagnosis is made through computed tomography scan and esophageal contrast studies. Treatment of BS is geared towards control of mediastinitis and sepsis, and repair of the perforation or reestablishment of the continuity of the gastrointestinal tract. We report the case of a 46-year-old male with BS, who was initially managed with a conservative resection of the perforated esophagus 48 hours after the onset of symptoms. When the mediastinitis persisted we decided to do a subtotal esophagectomy and subsequent esophageal reconstruction.
Esophagectomy

No abstract available.
Esophagectomy* ; Stomach*

Background: Esophageal cancer is a common disease at Digestive Surgery Department of Binh Dan hospital. Surgical treatment is still a main procedure. Objectives: Study on a less invasive surgical technique in esophagectomy with supported thoracoscopy to provide a new esophageal cancer treatment. Subjects and method: Application on a new technique via thoracoscopy to esophagectomy totally in 6 patients (1 female, 5 males), aged 60 years on average, treated in Digestive Surgery Department of Binh Dan hospital from March 2006 to June 2006. Results: The average surgical time was 260 minutes. There was no event during operation. Postoperative complications included: 1 patient had to stitch abdominal wall after operative 7 days, 3 patients with pneumonia after successful operation, 2 patients with right pneumothorax, having to put siphonage. There was one case of death without related to operative technique. Conclusion: Esophagectomy is major operation that can be conducted via open surgery or laparoscopic surgery. Although small case studies, researchers found that laparoscopic surgery is a feasible technique, can be performed safely if the surgeons having experience in open surgery and good skills on laparoscopic surgery. However, thoracoscopic esophagectomy can only be considered as a surgical method, without an alternative method to traditional open surgery.
Esophagectomy ; Esophageal Neoplasms/surgery ; Thoracoscopy ;

Esophagectomy is the major treatment for a variety of esophagus diseases. However, despite its wide applications, it is also one of the highest-risk procedures. Thus, reduction of mortality and complication after esophagectomy has drawn much attention, and the definition, classification and prediction of complication following esophagectomy is of vital importance. Unfortunately, there is no unified definition and specific prediction system for complications of esophagectomy until now. We review the advances in complication research in order to offer references to reduce mortality, prevent or treat complications of this high-risk operation.
Esophageal Diseases ; surgery ; Esophagectomy ; adverse effects ; Humans

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.
Enteral Nutrition ; Esophagectomy* ; Humans ; Jejunostomy* ; Nutritional Status

Previous studies reported that ultrathin endoscope (UE) provides endoscopic guidance during insertion of a self-expanding metal stent (SEMS) without fluoroscopic monitoring in patients with upper gastrointestinal stenosis (benign or malignant) or postoperative esophageal leakage. According to the type of SEMS and level of the stenosis, the technique of the procedure is variable. Herein, we report a patient who underwent placement of a distal release esophageal SEMS to treat an esophagogastric anastomotic stricture via retroflexed UE.
Constriction, Pathologic* ; Endoscopes ; Endoscopy* ; Esophagectomy ; Humans ; Stents*

Postoperative chylothorax following an injury to the thoracic duct during an esophagectomy is a rare, but severe complication, which may lead to serious problems, such as loss of fat and proteins, as well as immunodeficiency. Left untreated, the rate of mortality can rise to over 50%. Herein, 3 patients were treated with a postoperative chylothorax following 280 resections of the esophagus (0.1%). One patient underwent a direct injured thoracic duct ligation by a re-thoracotomy. In the other two patients, relaparotomy and transabdominal double ligation of the thoracic duct were performed. After ligation of the abdominal thoracic duct, the average amount of chyle was markedly reduced. Two patients were discharge from hospital without problems after 36 and 30 days, respectively. Ligation of the thoracic duct, via a relaparotomy, appears to be a simple and safe method for the treatment postoperative chylothorax.
Chyle ; Chylothorax* ; Esophagectomy* ; Esophagus ; Humans ; Ligation* ; Mortality ; Thoracic Duct*

Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Lymph Node Excision

Esophageal surgery has developed for almost 100 years. Esophagectomy can be performed via left, right thoracotomy, even via hiatus without thoracotomy due to its unique anatomic characteristics. Left thoracotomy was the initial approach in the world, and has still been performed by Chinese colleagues, but Ivor Lewis (right side thoracotomy) procedure is popular in western countries. Currently, esophagectomy by right thoracotomy has been accepted worldwide since its radical dissection for tumor. Therefore, video-assisted thoracoscopic esophagectomy based on right thoracotomy will be the mainstream surgery for esophageal cancer in the future since its minimal invasion and tumor dissection.
Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Thoracoscopy ; methods

OBJECTIVETo evaluate the outcomes of thoraco laparoscopic esophagectomy venus open esophagectomy for esophageal cancer.

METHODSLiterature search was performed using PubMed, Embase, Cochrane Library, and Google Scholar databases, CBM, and CNKI from inception to July 2011 for comparative studies assessing thoraco laparoscopic esophagectomy and open esophagectomy. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using RevMan 5.1.

RESULTSA total of 10 studies involving 1017 patients were included for the analysis. Four hundred and fifty-five patients underwent thoraco laparoscopic esophagectomy and 562 patients underwent open esophagectomy. There were no significant differences between the two groups in anastomotic leak, 30-day mortality, and number of lymph node retrieved(P>0.05). However, thoraco laparoscopic esophagectomy had lower blood loss, less operative time, and reduced respiratory complications(P<0.05). There were no significant differences between the two groups in overall complications, cardiac complications, anastomotic stricture, recurrent laryngeal nerve injury, length of stay, ICU stay, and 3-year survival(all P>0.05).

CONCLUSIONThoraco laparoscopic esophagectomy for esophageal cancer is feasible and safe as open esophagectomy.