Paediatric laparoscopic Heller's cardiomyotomy: a single centre series

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Esophageal Disorders

Background:

• Optimal management for pediatric esophageal achalasia is not well-defined due to its rarity.
• This study evaluates institutional experience with laparoscopic Heller's cardiomyotomy (HC) to determine the best treatment approach.

Purpose of the Study:

• To assess the efficacy and long-term outcomes of laparoscopic Heller's cardiomyotomy (HC) in children with esophageal achalasia.
• To identify the most appropriate treatment strategy for this rare pediatric condition.

Main Methods:

• Retrospective review of pediatric patients who underwent laparoscopic HC at a single institution.
• Analysis of demographics, pre-operative diagnostics, interventions, and post-operative outcomes.
• Data collection included pre-operative esophageal balloon dilatation (OBD), upper gastrointestinal contrast series, endoscopy, and manometry.

Main Results:

• Twenty-eight children (13 male, 15 female) with a median age of 13 years underwent laparoscopic HC.
• Nine patients had prior esophageal balloon dilatation (OBD); one had botulinum toxin and one had Nifedipine.
• Twenty-seven of twenty-eight patients achieved good outcomes, with seven requiring post-operative OBD and four needing redo HC.

Conclusions:

• Laparoscopic Heller's cardiomyotomy (HC) is an effective long-term treatment for pediatric esophageal achalasia.
• The procedure is successful with or without concomitant fundoplication.
• Esophageal balloon dilatation (OBD) for persistent symptoms post-HC may prevent the need for redo myotomy.