Intrapleural vacuum bandage in the treatment of spontaneous rupture of the esophagus

Objective. To improve treatment of patients with spontaneous esophageal rupture by suturing the esophageal defect through thoracotomy, staged debridement of pleural cavity and posterior mediastinum with application of a vacuum-assisted dressing. Material and methods. The study involved 22 patients with spontaneous esophageal rupture. They were divided into two groups depending on treatment: group 1 (n=12) — video-assisted thoracoscopic debridement of pleural cavity with vacuum dressing in esophageal lumen (endovacuum); group 2 (n=10) — thoracotomy, debridement of esophageal cavity, suturing the lower third of the esophagus, and placement of vacuum dressing in posterior mediastinum, pleural cavity, and post-thoracotomy wound. Treatment outcomes were compared between groups. Results. Mean length of postoperative hospital stay was 52 [48–55] and 14 [12–17] days, respectively. Mortality in group 1 was 16.7% (2 patients). There were no fatal outcomes in group 2. Conclusion. Esophageal wall perforation suturing no later than three days after injury through thoracotomy, thorough necrectomy, intrapleural vacuum-assisted dressing and staged pleural debridement improve the rate of favorable outcomes. This organ-sparing method is effective, significantly reduces hospital-stay and provides good quality of life in late postoperative period.