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Paediatric laparoscopic Heller's cardiomyotomy: a single centre series.

Max J Pachl1, Dean Rex1, Paolo Decoppi1

  • 1Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.

Journal of Pediatric Surgery
|February 18, 2014
PubMed
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Laparoscopic Heller's cardiomyotomy (HC) is an effective treatment for achalasia in children. This procedure, even without fundoplication, offers good long-term outcomes and may reduce the need for repeat surgeries.

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.
Keywords:
ChildrenEsophageal achalasiaHeller’s procedureLaparoscopic

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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.