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

"Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscop and gastroscop "

Reviewed by Reza Lankarani M.D

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World Journal of Emergency Surgery

Published: 07 June 2025

https://doi.org/10.1186/s13017-025-00630-6

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This retrospective study (2014-2024, n = 24) evaluates a novel lavage-drainage technique for spontaneous esophageal rupture (SER/Boehhaave's syndrome).

Patients undergoing VATS debridement/drainage were divided into:

1. Lavage-Drainage Group (n = 11): Gastroscopically guided placement of a nasogastric tube through the esophageal fistula for continuous irrigation (iodinated saline) + standard thoracic/mediastinal drainage.

2. Drainage Group (n = 13): Standard VATS debridement/drainage alone.

No Difference: Operative time, ICU/hospital stay, mechanical ventilation duration.

The authors conclude that fistula lavage enhances drainage efficiency, reduces inflammation, and improves SER prognosis but requires cost optimization.

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Comparison to Recent Literature:

VATS as Standard: Confirms VATS as the preferred minimally invasive approach for stable SER patients, aligning with consensus (Elliott et al., Surg Endosc 2019; Haverman et al., Surg Endosc 2011).

Beyond Basic VATS Drainage: Addresses limitations of simple VATS drainage (tube blockage, inadequate clearance) highlighted by Yu et al. (J Int Med Res 2018). The lavage technique offers a solution similar in spirit to "two-tube" methods but with direct fistula access.

Lavage Concept Supported: Hanajima et al. (J Thorac Dis 2021) also reported success with VATS-guided lavage/drainage (lower mortality, shorter hospital stay in historical controls), providing external validation for the lavage concept, though without the gastroscopic fistula cannulation.

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Conclusion & Significance:

Huang et al. present a promising technical advancement in managing SER. The combined thoracoscopic-gastroscopic lavage-drainage technique demonstrates potential for reducing mortality and severe complications compared to standard VATS drainage alone, particularly in delayed presentations. Its strength lies in directly addressing a key failure mode of traditional drainage (tube blockage) through enhanced debridement and controlled fistula management.

However, the small, retrospective, single-center nature of the study is a major limitation. The observed benefits, while clinically compelling, require confirmation in larger, prospective, multi-center studies with longer follow-up and detailed cost-effectiveness analyses. This technique represents a valuable addition to the "damage control" armamentarium for SER but should be considered within the context of available expertise and resources due to its complexity and higher initial cost.

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Reza Lankarani M.D

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