Laparoscopic and thoracoscopic esophagomyotomy for children with achalasia

Background: Minimally invasive esophagomyotomy, consisting of a laparoscopi c or thoracoscopic approach, has become a preferred surgical treatment for adults with achalasia. This multicenter study reports on the clinical statu s of children who have undergone minimally invasive esophagomyotomy for ach alasia. Methods: Symptomatology for achalasia was assessed in 22 pediatric patients who underwent minimally invasive esophagomyotomy for achalasia between 199 5 and 2000. All patients were evaluated for duration of hospitalization, po stoperative resumption of feeds, postoperative complications, and symptomat ic relief. Participants were assigned pre- and postoperative symptom severi ty scores ranging from 0 (no symptoms) to 3 (severe). Results: The median age of the 10 females and 12 males at time of surgery w as 11.3 years +/- 3.4 (standard deviation). Transabdominal laparoscopic eso phagomyotomy with fundoplication was performed in 18 patients, and thoracos copic esophagomyotomy without fundoplication was performed in 4. Two patien ts required conversion from transabdominal laparoscopic esophagomyotomy to open esophagomyotomy because of intraoperative esophageal perforation. The mean duration of postsurgical follow-up was 17 +/- 16 (standard deviation) months (range, 1-54 months). Mean duration of hospitalization (days standar d error or mean) was less for transabdominal laparoscopic esophagomyotomy t han for converted open esophagomyotomy (2.7 +/- 0.3 vs. 9.0 +/- 3.0 days; P < 0.05) or for thoracoscopic esophagomyotomy (4.8 +/- 1.7 days; P = not si gnificant). Mean time to resumption of soft feedings (days +/- standard err or or mean) occurred sooner after transabdominal laparoscopic esophagomyoto my than after converted open esophagomyotomy (2.0 +/- 0.2 vs. 5.5 +/- 0.5 d ays; P < 0.001) or after thoracoscopic esophagomyotomy (4.0 +/- 1.3 days; P = not significant). Patients experienced significant pre- to postoperative improvement in mean severity score with regard to dysphagia (2.6 vs. 0.4; P < 0.001) and regurgitation (1.7 vs. 0.2; P < 0.001). Conclusions: Minimally invasive esophagomyotomy can provide excellent sympt omatic relief from dysphagia and regurgitation for children with achalasia.