Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia in Children

Abstract

ABSTRACT

The surgical treatment of achalasia offers patients excellent results; however, surgery is often recommended only after multiple failed attempts at nonoperative management. The authors review their experience with laparoscopic Heller myotomy and Dor fundoplication in children. This is a retrospective review of eight consecutive children with achalasia who underwent laparoscopic Heller myotomy and Dor fundoplication. The average age was 14.5 years (range 11–17). Symptoms were documented by a severity score. Operative time, complications, outcome, and patient satisfaction were examined. All eight children had high-grade symptoms. All were evaluated preoperatively with upper gastrointestinal series and manometry, and the findings were consistent with achalasia. The laparoscopic procedure with Dor fundoplication was used for all eight children. The results have been excellent with minimal complications, resolution of preoperative symptoms, and hospital stays of 2 days in seven of eight patients. Patients have been followed up for ≤24 months postoperatively, with continued excellent results. The advantages of the laparoscopic operation include the ability to extend the myotomy distally onto the stomach to ensure adequate release of the stricture and to add a fundoplication to prevent reflux. In the authors' experience, there was no difficulty obtaining adequate exposure of the thoracic esophagus in order to extend the myotomy cranially. The children in this series had excellent results, with relief of their preoperative symptoms, minimal morbidity, and almost no evidence of reflux postoperatively. Consideration should be given to surgery as an early form of treatment for achalasia.