Related Experiment Video
Updated: Feb 26, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Pediatric achalasia. Single-center study of interventional treatment
Andrzej Grabowski1, Wojciech Korlacki1, Michał Pasierbek1
1Department of Children's Developmental Defects Surgery and Traumatology in Zabrze, Medical University of Silesia in Katowice, Poland.
Insights
Laparoscopic Heller's myotomy is effective for pediatric achalasia, with an 82% success rate. Endoscopic balloon dilatation can complement surgery, particularly for redo procedures in children with esophageal achalasia.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Esophageal motility disorders
Background:
- Esophageal achalasia is rare in children, with surgery often preferred due to treatment failure with conservative methods.
- Laparoscopic Heller's myotomy is the standard surgical approach at our institution for pediatric achalasia.
Purpose of the Study:
- To evaluate the surgical outcomes of treating achalasia in pediatric patients.
- To assess the long-term efficacy and safety of laparoscopic Heller's myotomy in children.
Main Methods:
- Retrospective analysis of 11 pediatric patients (ages 6-17) who underwent laparoscopic Heller's myotomy between 1997 and 2014.
- Data collected included demographics, symptoms, diagnostics, surgical procedures (myotomy with fundoplication), complications, and long-term follow-up (1-10 years).
- Pneumatic dilatation was used adjunctively, but not as a sole treatment.
Main Results:
- Twelve laparoscopic Heller's myotomies were performed, with 10 Toupet and 2 Dor fundoplications; one patient had a redo procedure.
- The overall success rate was 82%, with some requiring subsequent dilatations.
- Two intraoperative perforations were successfully managed; one case failed due to disease progression.
Conclusions:
- Laparoscopic Heller's myotomy is the recommended surgical treatment for pediatric achalasia.
- Endoscopic balloon dilatation serves as a valuable complementary therapy, especially for redo procedures.
Introduction:
Esophageal achalasia is a rare entity in children. However, young age is a factor of failure of conservative treatment, emphasizing the role of surgery. In our institution laparoscopic Heller's cardiomyotomy is the chosen procedure for surgical treatment.
Aim:
To assess the outcome of surgery for achalasia treatment in children operated on in a single institution.
Material And Methods:
A retrospective analysis of consecutive patient records from the years 1997 to 2014 was performed. There were 11 patients. Their mean age was 13 years, ranging from 6 to 17. Duration of symptoms was 2 to 36 months, mean 16. All 11 patients were operated on with a laparoscopic approach. Pneumatic dilatation was used both pre- and postoperatively but in no case was sufficient on its own. Collected data included patient demographics, preoperative symptoms and their duration, diagnostic findings and therapeutic means. Surgical procedures, complications and long-term follow-up were analyzed. The follow-up lasted from 1 to 10 years and finished when the patient reached 18 years of age.
Results:
Twelve laparoscopic cardiomyotomies were performed with concomitant fundoplications, 10 Toupet and 2 Dor and one redo procedure. There were no deaths. Two perforations were repaired promptly. The success rate was 82%, though with subsequent dilatations. One failure was due to serious progression of the disease.
Conclusions:
In our opinion, laparoscopic Heller's myotomy is the procedure of choice for treating achalasia in children. Endoscopic balloon dilatation may be used as a complementary treatment, especially as a primary redo procedure.
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