Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children

Background/Purpose: In the past, surgical treatment in achalasia usually ha s been reserved for patients whose dysphagia does not respond to pneumatic dilatation. The success of minimally invasive myotomy, however, has resulte d in a shift in practice in adult patients, whereby laparoscopic surgery is becoming preferred as primary treatment by most gastroenterologists and su rgeons. The aim of this study was to assess the efficacy of laparoscopic He ller myotomy and Dor fundoplication for esophageal achalasia in children. Methods: Thirteen patients with esophageal achalasia (median age, 15 years; 6 boys and 7 girls; median duration of symptoms, 24 months) underwent lapa roscopic Heller myotomy and Dor fundoplication between 1996 and 1999. Two p atients had been treated previously by pneumatic dilatation, and 1 patient had received intrasphincteric Botulinum toxin injections. Results: Median duration of the operation was 130 minutes. The patients wer e fed after an average of 33 hours, and they all left the hospital within 2 days. At a median follow-up of 19 months, there was no residual dysphagia in any patient. Conclusions: Laparoscopic Heller myotomy and Dor fundoplication were effect ive and safe for children with esophageal achalasia. Hospital stay and reco very time was short, and the functional results were excellent. These data support the notion that laparoscopic Heller myotomy should become the prima ry treatment of esophageal achalasia in children. J Pediatr Surg 36:1248-12 51. Copyright (C) 2001 by W.B. Saunders Company.