Thoracoscopic Heller Myotomy for Achalasia in a 3-Year-Old Child

Abstract

Permanent relief of symptomatic achalasia most often occurs after longitudinal esophagomyotomy. A serious drawback of this treatment has been the need for a thoracotomy or laparotomy. We report a case of esophagomyotomy using a minimally invasive thoracoscopic technique in a 3-year-old child who presented with a 6-month history of regurgitation and recurrent upper respiratory tract infections. An upper gastrointestinal series demonstrated a bird's beak at the lower esophageal sphincter. The patient underwent a left thoracoscopic modified Heller esophagomyotomy. Under endoscopic guidance, the myotomy was performed from the inferior pulmonary vein to a distance 1 cm distal to the gastroesophageal junction. The patient was discharged home on the third postoperative day. Thoracoscopy combined with endoscopy provides a patient with definitive surgical treatment for achalasia while avoiding the need for an antireflux procedure. The above patient is the youngest reported in the literature to have undergone this procedure. The case illustrates the efficacy of the minimally invasive technique for a Heller esophagomyotomy in young children.