Boerhaave's syndrome usually has a high rate of mortality whether managed conservatively or surgically. Some of the patients who are initially stable and are managed conservatively, deteriorate over a period requiring surgery or high life support eventually with high mortality. Would these patients have fared better have they been operated earlier ?
There is a problem to obtain strong evidence regarding most efficient treatment as the syndrome is rarity. However some studies suggest that primary nonoperative management is related with high failure rate and mortality compared to surgery. The best outcomes when you look at the literature comes with early surgical repair of the esophageal defect reinforced with gastric fundus. However there is no papers with high grade of evidence. Refer to the articles below:
http://sjs.sagepub.com/content/102/4/271.full.pdf+html
http://www.ingentaconnect.com/content/sesc/tas/2013/00000079/00000006/art00027?token=004d10bb383a4b3b2570747b6c7a2438595774664c2a726e2d2954496f642f466f65758757218
This syndrome represent the most dangerous perforation of all upper GI. Mortality rate can be as high as 50% after 24H from the event, so early diagnosis and appropriate surgical treatment is mandatory to reduce mortality. Even with an timely diagnosis and a correct management mortality is about 30%... so even according to literature conservative management have no role in Boerhaave Syndrome.
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