LONG-TERM RESULTS OF SURGERY FOR CHILDHOOD ACHALASIA

Childhood achalasia is an uncommon condition characterised by the abse nce of oesophageal peristalsis together with increased resting pressur e and failure of relaxation of the lower oesophageal sphincter. The cu rrently accepted management is a modified Heller's cardiomyotomy with Nissen fundoplication; however, the long-term results are uncertain. A retrospective review of the notes of 10 children undergoing surgical treatment of achalasia at our institution over a 23-year period were r eviewed. There were six boys and four girls. The median age at onset o f symptoms was 123 months and at diagnosis was 133 months. Five childr en were below average weight at the time of presentation. All underwen t a modified Heller's operation and Nissen fundoplication. The follow- up ranged from 12 to 277 months with a mean of nearly 10 years. The re sults were excellent in terms of symptomatic improvement in eight of t en with one good and one moderate outcome. All children below average weight have shown improvement postoperatively. We would conclude that the management of achalasia in childhood should consist of an extended Heller's cardiomyotomy performed by the abdominal approach with the a ddition of an antireflux procedure such as Nissen fundoplication.