V-07. Minimally Invasive Transhiatal Dual-Layer Repair of Esophageal Rupture in Boerhaave Syndrome

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ID: 326055
2026
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Abstract
Abstract Topic Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications Background Open thoracotomy and laparotomy have traditionally been regarded as the standard surgical approaches for esophageal rupture in Boerhaave syndrome. However, these procedures are associated with significant surgical trauma and postoperative morbidity. Minimally invasive techniques may reduce perioperative morbidity while maintaining effective source control. In selected patients with lower esophageal perforations, a laparoscopic transhiatal approach offers direct access to the site of injury and mediastinal contamination. Methods We report a case of a 60-year-old female who presented with acute dysphagia and retching following ingestion of a large food bolus, subsequently developing fever and tachycardia. Computed tomography demonstrated a large right-sided hydropneumothora. Following endoscopic removal of the impacted food bolus, a perforation was identified in the distal esophagus. The patient underwent emergency laparoscopic transhiatal repair. A standard four-port laparoscopic technique was utilized. After hiatal dissection, mobilization of the distal esophagus, and drainage of the lower mediastinal abscess cavity, the perforation was identified on the right posterolateral wall of the distal esophagus. The mucosal layer was carefully dissected from the muscular layer, and longitudinal myotomy was extended proximally and distally to fully delineate the extent of the mucosal defect. Separate closure of the mucosal and muscular layers was performed to achieve a secure dual-layer repair. An omental flap was used to buttress the repair. Results The patient received broad-spectrum antimicrobial therapy and adequate pleural drainage. A water-soluble contrast swallow performed on postoperative day 10 demonstrated no evidence of contrast extravasation. Oral intake was subsequently resumed and advanced without complication. The patient made an uneventful recovery. Interval endoscopy at 5 months demonstrated a normal distal esophagus with no evidence of stricture or mucosal abnormality. Conclusion Laparoscopic transhiatal repair is a safe and feasible option for selected patients with lower esophageal perforation in Boerhaave syndrome. Dual-layer closure provides superior mechanical strength and may promote improved healing compared with single-layer repair, while avoiding the morbidity associated with open surgical approaches. Video Description This video demonstrates a step-by-step laparoscopic transhiatal dual-layer repair of distal esophageal perforation in a patient with Boerhaave syndrome. While open thoracotomy and laparotomy have traditionally been considered the standard approach for esophageal rupture, minimally invasive strategies remain underrepresented due to technical complexity and concerns regarding adequacy of repair and mediastinal source control. This video highlights a reproducible laparoscopic technique for selected lower esophageal perforations. The video begins with the case description of the patient, a 60 year old female presenting with Boerhaave syndrome. Key operative steps are then demonstrated. The site of the perforation is identified at the right posterolateral wall of the distal esophagus near the gastroesophageal junction. A major focus of the video is the technical execution of a true dual-layer repair. The mucosal layer is meticulously dissected from the muscular layer, and longitudinal myotomy is extended to fully delineate the mucosal defect. Separate closure of the mucosal and muscular layers is performed, followed by omental buttressing of the repair. This video is unique in its detailed depiction of mucosal–muscular layer separation and dual-layer closure in a minimally invasive setting, techniques that are seldom illustrated in laparoscopic esophageal perforation repair. This case demonstrates that laparoscopic transhiatal dual-layer repair is a safe, effective, and feasible option for selected patients with distal esophageal perforation, offering an important minimally invasive alternative to open surgery.
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Authors Tiffany J Y Lye, Hock Soo Ong, Zhen Jin Lee, Eugene K W Lim, Weng Hoong Chan, Wai Keong Wong, Nan Guang Tan, Chin Hong Lim, Alvin K H Eng, Jie Qi Lim, Jeremy T H Tan
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.407
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.407/70760630/doag077.407.pdf
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