Surgical Outcome of Oesophageal Diversion and Exclusion Procedure in the Management of Oesophageal Perforation: A Retrospective Observational Study

Introduction: Oesophageal perforation is a life-threatening condition with high mortality rates. Various treatment options are available for the management. Oesophageal exclusion with diversion completely diverts the secretions entering the mediastinum, thereby prevents mediastinitis. Aim: The present study aimed to estimate mortality and the causes of oesophageal perforation in patients who underwent oesophageal exclusion and diversion procedure. Materials and Methods: The present retrospective observational study was conducted in Surgical Gastroenterology Department at Madras Medical College,Tamil Nadu, India from January 2019 to May 2024. A total of 46 patients had oesophageal perforation; 14 patients were managed conservative treatment, 32 patients were managed by operative treatment, including 25 patients who underwent oesophageal exclusion and diversion procedure. The surgical outcome of these 25 patients who underwent diversion cervical oesophagostomy and oesophageal exclusion for oesophageal perforation were evaluated. Parameters like age, sex, cause of perforation, location of oesophageal perforation, duration from symptom onset to hospital admission, postoperative morbidity, and mortality were recorded. Results: The mean age of the patients was 44.16 years, with 16 male and 9 female. Mortality rate was 4 (16%). The thoracic portion of the oesophagus was the most common site of perforation in 24 (96%) patients. Spontaneous perforation (9 patients, 36%) was the most common cause of oesophageal perforation, followed by foreign body-induced perforation (8 patients, 32%). Conclusion: Oesophageal diversion and exclusion procedure can be safely performed in a septic patients and in patients with delayed presentation. Oesophagostomy reversal is also an easy technique that does not cause much morbidity to the patients. In most of the patients, oesophagostomy that spontaneously closed doesn’t require reversal.