Work

Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscopic and gastroscopic management

Year: 2025

Type: article

Abstract: BACKGROUND: Spontaneous esophageal rupture (SER) is a rare and severe emergency with high mortality, and the treatment algorithm remains controversial. METHODS: This retrospective study analyzed SER cases that underwent VATS debridement and drainage in Jinling Hospital from January 2014 to July 2024. Patients were divided into Lavage-Drainage and Drainage groups based on whether they received a lavage tube cathetering through the esophageal fistula under gastroscope. Preoperative fluid resuscitation, thoracoscopic mediastinotomy, and thoracic debridement were performed. Post-operative management included fasting, enteral nutrition, anti-infective agents, and fluid and electrolyte balance maintenance. Monitoring indicators included vital signs, laboratory test results, postoperative complications, and other relevant factors. RESULTS: A total of 24 patients were enrolled, with 11 in the Lavage-Drainage group and 13 in the Drainage group. The Lavage-Drainage group had lower 30-day mortality, fewer complications and adverse events, and a faster reduction in inflammatory factors, but a higher cost. There was no significant difference in the length of mechanical ventilation, hospital stay, and ICU stay. CONCLUSIONS: The Lavage-Drainage approach enhanced the drainage efficiency, reduced the inflammation level, and improved the prognosis of SER. However, this study has some limitations, and further multi-center prospective studies are needed to optimize the treatment and reduce costs.

Source: World Journal of Emergency Surgery

DOI: 10.1186/s13017-025-00630-6