Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Apr 18, 2023; 11(4): 112-124
Published online Apr 18, 2023. doi: 10.13105/wjma.v11.i4.112
Current approach for Boerhaaves syndrome: A systematic review of case reports
Ippei Yamana, Takahisa Fujikawa, Yuichiro Kawamura, Suguru Hasegawa
Ippei Yamana, Takahisa Fujikawa, Yuichiro Kawamura, Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
Suguru Hasegawa, Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
Author contributions: Yamana I and Fujikawa T contributed equally to this work; Yamana I and Fujikawa T designed the research study; Yamana I and Fujikawa T performed the research; Kawamura Y contributed new reagents and analytic tools; Yamana I analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takahisa Fujikawa, FACS, MD, PhD, Chief Doctor, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan. fujikawa-t@kokurakinen.or.jp
Received: December 16, 2022
Peer-review started: December 16, 2022
First decision: January 31, 2023
Revised: February 7, 2024
Accepted: April 6, 2023
Article in press: April 6, 2023
Published online: April 18, 2023
Processing time: 119 Days and 3.6 Hours
Abstract
BACKGROUND

There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches. We conducted a systematic review of case reports documenting Boerhaave syndrome.

AIM

To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.

METHODS

We searched PubMed, Google scholar, MEDLINE, and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.

RESULTS

Of the included studies, 49 were case reports, including a total of 56 cases. The mean age was 55.8 ± 16 years old. Initial conservative treatment was performed in 25 cases, while operation was performed in 31 cases. The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission (9.7% vs 44.0%; P = 0.005). Seventeen out of 25 conservative cases (68.0%) were initially treated endoscopic esophageal stenting; 2 of those 17 cases subsequently underwent operation due to poor infection control. Twelve cases developed postoperative leakage (38.7%), and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage. The length of the hospital stay was not significantly different between the conservative treatment and operation cases (operation vs conservation: 33.52 ± 22.69 vs 38.81 ± 35.28 days; P = 0.553).

CONCLUSION

In the treatment of Boerhaave syndrome, it is most important to diagnose the issue immediately. Primary repair with reinforcement is the gold-standard procedure. The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.

Keywords: Boerhaave syndrome; Esophageal perforation; Self expandable metalic stent; Minimally invasive surgical procedures; Anastomotic leakage; Shock

Core Tip: Totally 49 published case reports concerning the Boerhaave syndrome were systematically reviewed. In the treatment of Boerhaave syndrome, it is most important to diagnose the issue immediately. Primary repair with reinforcement is the gold-standard procedure. The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.