THE SURGICAL APPROACH TO ESOPHAGEAL ACHALASIA

The term ''oesophageal achalasia'' describes a neuropathic disorder ch aracterized by abnormal motility of the oesophagus and incomplete or a bsent relaxation of the lower oesophageal sphincter. In these patients with ''paroxysmal'' dysphagia, barium swallow and manometric study co nfirm the diagnosis. In our opinion, the treatment of choice is extram ucosal cardiomyotomy (Heller) which should be followed by gastric fund oplication in order to protect the mucosa and prevent gastrooesophagea l reflux. We present our experience in the laparoscopic approach to He ller cardiomyotomy in children. An anterior 180 degrees hemi-fundoplic ation, according to Dor technique, is performed suturing the left and right oesophageal muscular margin to the gastric wrap. A manometric ex amination is mandatory in order to detect the complete incision of the lower oesophageal sphincter and to confirm the creation of the new-hi gh pressure zone. This preliminary experience confirms that the laparo scopic approach can be used for the treatment of oesophageal achalasia also in children.