Boerhaave's syndrome: a continuing challenge in thoracic surgery.

Background/Aims: Boerhaave's syndrome accounts for 30-40% of esophageal disraption. The current literature regarding the management of these patients and problems in treatment remains controversial. Methodology: Between 1988 and 1998, 14 patients with Boerhaave's syndrome were treated in our unit Five primary repairs and 9 esophagectomies were performed. A retrospective review of these patients' records was carried out. The patients were divided into two groups. Group I: minor esophageal leak, local mediastinitis and hyperdynamic septic shock. All 5 cases were treated by primary repair. Group II: moderate to severe esophageal leak, severe mediastinitis and hypodynamic septic shock. All 9 cases were treated by transthoracic esophagectomy, Results: Group I: No postoperative mortality. The mean ICU stay was 4.6 days. The mean hospitalization time was 14 days. Group II: The postoperative mortality was 22.2%. The mean ICU stay was 28 days. The mean hospitalization time was 45 days. Conclusions: The choice of which operative approach should be made in patients with Boerhaave's syndrome requires critical assessment of the patient's overall status, the duration of leak and the extent of mediastinal and pleural contamination.