In late cases of Boerhaave's syndrome, what alternative procedure is typically performed?

In late cases of Boerhaave's syndrome, split fistula creation is a commonly employed alternative procedure. Boerhaave's syndrome represents a spontaneous rupture of the esophagus, typically due to severe vomiting. If the condition is identified early, prompt surgical repair may be possible. However, in late presentations, especially when there is significant contamination and the potential for complications like mediastinitis, primary repair may not be viable.

The choice of creating a split fistula involves creating a controlled fistula that can drain the esophagus while allowing for healing. This approach can help manage the contents of the esophagus and reduce the risk of ongoing infection and additional complications. It allows for the esophagus to undergo periods of rest and recovery while diverting the esophageal contents outside of the thoracic cavity.

In contrast, while other procedures might address esophageal obstruction or nutritional needs, they do not specifically resolve the complex issues presented by a late rupture. Options like gastrostomy tube placement are more focused on providing nutrition but do not address the direct complications resulting from the rupture. Endoscopic surveillance does not offer a solution for the rupture itself in a late presentation, and primary repair is often not feasible due to the inflammatory changes that have taken place.

Thus, split