C. Esposito et al., Laparoscopic esophagomyotomy for the treatment of achalasia in children - A preliminary report of eight cases, SURG ENDOSC, 14(2), 2000, pp. 110-113
Citations number
23
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
Background: Albeit rare in children, achalasia is a disorder with severe sy
mptoms that causes growth impairment. The treatment of choice in children i
s the esophagomyotomy, although there are variations in the surgical approa
ches available and differences of opinion regarding the inclusion of an adj
unctive antireflux procedure. The recent advent of the laparoscopic approac
h has had a profound impact on the treatment of achalasia in both adults an
d children.
Methods: In this report, we describe eight patients with severe achalasia w
ho were treated by laparoscopic Heller's operation associated with a fundop
lication according to either Dor's or Toupet's technique. The patients' age
s ranged between 2 and 13 years. A five-port technique was used: a 10-mm po
rt placed infraumbilically for the optics and four 5-mm ports. One was plac
ed in the right abdominal quadrant for retraction of the left hepatic lobe,
one in the left abdominal quadrant for the first operative instrument, one
below the xyphoid appendix for the second operative instrument, and the la
st one to introduce a 5-mm cannula laterally to the umbilicus to retract th
e stomach below, A 7-8-cm laparoscopic Heller esophagomyotomy was completed
, followed by an anterior Dor fundoplication in six cases and a Toupet in t
wo. The longitudinal division of the anterior esophageal musculature was pe
rformed with a scalpel or scissors. The myotomy was made along the stomach,
extending for greater than or equal to 2-3 cm.
Results: Mean operating time was 120 mine, Three complications were recorde
d. There were two perforations of the gastroesophageal mucosa; the first wa
s sutured in laparoscopy and the second required a second operation. The th
ird complication was a case of dysphagia resolved by dismounting a fundopli
cation that was too tight. At follow-up, which lasted from 6 months to 5 ye
ars, the children were all free of symptoms.
Conclusions: Laparoscopic Heller esophagomyotomy appears to be a complex an
d difficult operation, but it is as safe and effective as laparotomy in chi
ldren with achalasia, However, complications can be numerous and severe at
the beginning of a surgeon's experience.