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Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
[Outcome of laparoscopic Heller myotomy in children]
Insights
Laparoscopic Heller myotomy is a safe and effective treatment for pediatric achalasia, providing good long-term quality of life. This minimally invasive surgery offers durable symptom relief for children with this rare esophageal motility disorder.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Esophageal motility disorders
Context:
- Achalasia management in children is debated.
- Surgical intervention is considered after endoscopic treatment failure.
- Laparoscopic Heller myotomy with Dor fundoplication is a standard surgical approach.
Purpose:
- To evaluate the short- and mid-term outcomes of laparoscopic Heller myotomy in pediatric achalasia patients.
- To assess the safety and efficacy of the procedure.
- To determine the impact on patients' quality of life.
Summary:
- Six children with achalasia underwent laparoscopic Heller myotomy.
- The procedure was performed safely with no complications or conversions.
- At a median follow-up of 5 years, 5 out of 6 patients had normal eating habits, and all reported a good quality of life despite mild, infrequent dysphagia episodes.
Impact:
- Laparoscopic Heller myotomy provides effective and safe treatment for pediatric achalasia.
- The surgery offers a good and durable quality of life for affected children.
- This approach demonstrates long-term efficacy in managing this rare esophageal disorder.
Aim:
The appropriate management of achalasia in children remains debatable. The present study aimed to evaluate the outcome of laparoscopic Heller myotomy by assessing short- and mid-term issues.
Methods:
Children submitted to surgery from 2002 to 2010 were included. Surgery was proposed after failure of endoscopic dilatations. All patients underwent esophagocardiomyotomy (Heller) plus anterior fundoplication (Dor) by laparoscopy. Demographics, presentation symptoms and perioperative details were analyzed. The outcomes were assessed both by medical records and the application of a 14 items (score 0-worst to 4-best/normal) self-evaluation questionnaire (modified GIQLI - covering only upper gastrointestinal symptoms).
Results:
Six patients (5 males) with a median age of 12.2 years (range: 0.8-14.2) were submitted to surgery. The presenting symptoms were: dysphagia (83.3%), weight loss (50%), vomiting (33.3%), chronic cough (33.3%), and chest pain (16.7%). All patients were operated on by laparoscopy with no conversions; there were no intra or postoperative complications. At a median follow-up of 5 years (range: 2-10) none of the patients were re-operated. Five patients have normal eating habits; the remaining case presented recurrent episodes of dysphagia requiring regular endoscopic dilatations (every 6 months). The total GIQLI presented a mean score of 49.3 (range, 45-52) representing 88.1% of the theoretical maximum. The score for frequency of dysphagia episodes was 1.6 +/- 1.4; all patients scored 3 for the grade of dysphagia.
Conclusions:
Laparoscopic Heller myotomy is effective and safe for achalasia in children, offering a good and durable quality of life; although frequent, the dysphagia episodes were mild.
