Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate

Esophageal rupture, including spontaneous esophageal rupture [Boerhaave syndrome, first reported in 1724 (1,2)], is a life-threatening disease. Early diagnosis and treatment is needed for good outcome of the disease (3-5). However, the initial diagnostic accuracy rate for spontaneous esophageal rupture is reported to be approximately 30%. Moreover, the mortality rate is 20% to 40% due to severe respiratory failure (5-7). Surgical treatment is performed mainly for the disease, including primary suture with or without reinforcement, such as an omental patch; pleural, pericardial, or diaphragmatic pedicle flap; or fundic patch, and successive lavage and drainage of the thoracic cavity (4,6,8,9). Conservative treatment is selected in limited patients (10-12). There are few reports of thoracoscopic surgery for the disease (13-16). We have performed thoracoscopic surgery for esophageal disease, mainly for esophageal cancer, at our department since 1994 (17). We also have applied this procedure to benign diseases, including spontaneous esophageal rupture