Surgical Management of Esophageal Perforation

Esophageal perforations remain a challenging problem with significant morbidity and mortality. Accurate diagnosis to isolate the location and etiology of the injury, as well as associated upper gastrointestinal pathologies is vital to determine appropriate, prompt treatment plan. Management options include nonoperative resuscitation and medical management, endoscopic stenting and thoracoscopic decortication, primary repair with tissue flap buttress or esophageal diversion ± resection. Posterolateral thoracotomy and primary repair of the injury with reinforcement with a pedicled tissue flap is historically considered the standard treatment by which other treatments are measured. The thoracic surgeon should be skilled in all potential treatment algorithms to provide the best outcome for the patient in these difficult clinical scenarios.