Surgery of very late intrathoracic esophgeal ruptures and perforations

Objective: The reasons of delay and a more selective management of 7 unusually late esophageal disruptions is evaluated in this study. Material and methods: In case of a 13 day-old rupture, left transthoracic debribement, primary repair with hiatusplasty was done. In a 6 week-old postpneumonectomy leak, esophageal exclusion, fenestration, chemotherapy and Roux-en-Y bypass was performed. Closure with serratus anterior flap was used in a small esophageal leak with empyema which occured 4 months after pneumonectomy. In a iatrogenic, 9 day-old esophageal injury, suture, than Urchel type temporary exclusion was carried out. In a 6 week-old iatrogenic leak with localised empyema, Urchel-Ergin type exclusion with thoracostomy was used. As a first step esophageal exclusion and than decortication was performed in a 13 day-old rupture with empyema,followed by substenal colonic bypass 2 months later. In a 7 day-old transfixion esophgeal wound, suture with drainage was performed. The patient with closed esophagus was lost, for irreversibile sepsis. Results. Recovery time was 9 to 28 days. Conclusion: Even in such unique esophageal disruptions individual approach prove to useful.