Surgical management of Boerhaave's syndrome in a tertiary oesophagogastric centre

Sutcliffe et al. have produced a well-structured study which describes the surgical management of Boerhaave's syndrome which is quite a challenging job. Various studies have been performed to propose the best management for the patients who present late. The review by Wang et al.¹ describes the surgical management to achieve the best outcome and may lead to reduced mortality. The authors have described four patients who were managed conservatively though they were operated subsequently; however, the criteria for considering conservative management for these four patients is not clear. Also it has been shown that the fibrin tissue patch reinforcement of the primary repair yields better results than primary repair alone.² The principle of surgery remains the same, i.e. aggressive management with adequate mediastinal and pleural drainage and nutritional support.³ Use of stents is another option described but the indications for it are not clear. Whether a transhiatal approach should be considered when the re-operation rate was quite high as stated by the authors, is another debatable question.