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Esophageal trauma is a rare but life-threatening event associated with high morbidity and mortality. An inadvertent esophageal perforation can rapidly contaminate the neck, mediastinum, pleural space, or abdominal cavity, resulting in sepsis or septic shock. Higher complications and mortality rates are commonly associated with adjacent organ injuries and/or delays in diagnosis or definitive management. This article aims to delineate the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia, on the surgical management of esophageal trauma following damage control principles. Esophageal injuries should always be suspected in thoracoabdominal or cervical trauma when the trajectory or mechanism suggests so. Hemodynamically stable patients should be radiologically evaluated before a surgical correction, ideally with computed tomography of the neck, chest, and abdomen. While hemodynamically unstable patients should be immediately transferred to the operating room for direct surgical control. A primary repair is the surgical management of choice in all esophageal injuries, along with endoscopic nasogastric tube placement and immediate postoperative care in the intensive care unit. We propose an easy-to-follow surgical management algorithm that sticks to the philosophy of "Less is Better" by avoiding esophagostomas.

Mauricio Millan, Universidad Icesi, Cali, Colombia. Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5502-5745

Michael W Parra, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275

Boris Sanchez-Restrepo, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-6996-5439

Yaset Caicedo, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128

Carlos Serna, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1641-0421

Adolfo González-Hadad, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-5862-4906

Luis Fernando Pino, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854

Fabian Hernandez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-2974-0649

Fernando Rodríguez-Holguín, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5326-2317

Alexander Salcedo, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili.

orcid_id14.png https://orcid.org/0000-0001-8187-0638

José Julian Serna, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Centro Médico Imbanaco, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-9829-8930

Alberto Garcia, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434

Carlos Alberto Ordoñez, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405

Millan, M., Parra, M. W., Sanchez-Restrepo, B., Caicedo, Y., Serna, C., González-Hadad, A., Pino, L. F., Herrera, M. A., Hernandez, F., Rodríguez-Holguín, F., Salcedo, A., Serna, J. J., Garcia, A., & Ordoñez, C. A. (2021). Primary repair: damage control surgery in esophageal trauma. Colombia Medica, 52(2), e4094806. https://doi.org/10.25100/cm.v52i2.4806

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