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Late results following esophagomyotomy in children with achalasia
Insights
Modified Heller esophagomyotomy is a safe and effective treatment for pediatric achalasia, offering an 86% success rate. Esophageal dilatation proved ineffective, highlighting the need for long-term follow-up.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Achalasia is a rare esophageal motility disorder affecting children.
- Diagnosis in pediatric achalasia relies on imaging and manometric studies.
- Previous treatments like esophageal dilatation have shown limited success in children.
Purpose of the Study:
- To evaluate the safety and efficacy of modified anterior Heller esophagomyotomy in children with achalasia.
- To compare transabdominal versus transthoracic approaches for Heller esophagomyotomy.
- To assess the long-term outcomes and complications of surgical intervention for pediatric achalasia.
Main Methods:
- Retrospective review of 21 children diagnosed with achalasia between 1970 and 1986.
- All patients underwent modified anterior Heller esophagomyotomy (transabdominal or transthoracic).
- Follow-up included clinical assessment, barium swallow, and manometric studies.
Main Results:
- Modified Heller esophagomyotomy achieved 86% complete relief of obstruction.
- Zero mortality was observed in the series.
- Postoperative complications occurred in 42% of patients, primarily atelectasis and fever.
- Esophageal dilatation was ineffective in four patients.
- Gastroesophageal reflux (GER) developed in three patients, managed medically or surgically.
Conclusions:
- Modified Heller esophagomyotomy is a safe and effective treatment for pediatric achalasia, regardless of surgical approach.
- Esophageal dilatation is not recommended as a primary treatment for pediatric achalasia.
- Long-term follow-up is crucial due to persistent abnormal esophageal motility post-surgery.
Abstract:
Twenty one children with achalasia of the esophagus were treated from 1970 to 1986. There were 11 girls and ten boys (average age, 10.9 years; range, 6 months to 16 years). Diagnosis was established by barium swallow in 21 cases and confirmed by manometrics and motility studies in 14. Four children had unsuccessful dilatation (range, 1 to 16 dilatations/pt). All 21 children underwent modified anterior Heller esophagomyotomy (transabdominal in 15 and transthoracic in six). Concomitant Nissen fundoplication was performed in three. Follow-up from 1 to 14 years (mean, 6.3 years) showed complete relief of obstruction in 18 patients (86%), while three required additional procedures for persistent dysphagia. One child improved after a single dilatation, but two others eventually required a second esophagomyotomy. Three additional patients subsequently developed gastroesophageal reflux (GER), and two were managed with Nissen fundoplication; the third responded to medical management. The mortality for this series was zero. Postoperative complications occurred in nine children (42%) and was due to atelectasis and postoperative fever. Modified Heller esophagomyotomy is safe and effective in children with achalasia (mortality, 0%; relief of obstruction, 86%). Results were similar after a transabdominal or transthoracic approach. Esophageal dilatation was not an effective method of treatment. Although postsurgical barium swallow showed relief of obstruction, abnormal esophageal motility persisted, suggesting that long-term follow-up is important.