Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients

125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model.Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation.Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.A perforation of the oesophagus implies a serious therapeutic problem. If a mediastinitis develops the situation can become life threatening in a few hours. Strategies for aiding patients struck with this disease are changing as new and less traumatic treatment options are developing. The introduction of covered metallic esophageal stents (SEMS) has offered a less traumatic alternative. In this situation, when new methods are evaluated, it is important to have knowledge about how these patients have been treated in the past.Treatment of esophageal perforations remains controversial and no consensus has been reached on the best treatment option. This is a reflection of the fact that this condition is difficult to study with a high degree of scientific power. The incidence of esophageal perforation is low and limited clinical materials are still reported. In 1997 when Brauer and co-worker