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Long-term results of surgery for childhood achalasia
G Morris-Stiff1, R Khan, M E Foster
1Department of Paediatric Surgery, University Hospital of Wales, Cardiff.
Insights
This study reviewed 10 children with achalasia, finding that modified Heller
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Childhood achalasia is a rare esophageal motility disorder.
- It involves absent peristalsis and abnormal lower esophageal sphincter (LES) function.
- Current management, Heller's cardiomyotomy with Nissen fundoplication, has uncertain long-term outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy of modified Heller's cardiomyotomy with Nissen fundoplication in pediatric achalasia.
- To assess surgical outcomes and symptomatic improvement in children treated for achalasia.
Main Methods:
- Retrospective review of 10 pediatric achalasia patients over 23 years.
- All patients underwent modified Heller's cardiomyotomy and Nissen fundoplication via abdominal approach.
- Follow-up ranged from 12 to 277 months (mean ~10 years).
Main Results:
- Excellent symptomatic improvement in 8/10 children; one good and one moderate outcome.
- All underweight children showed postoperative weight improvement.
- No specific complications were detailed, but overall outcomes were positive.
Conclusions:
- Extended Heller's cardiomyotomy via abdominal approach with Nissen fundoplication is effective for childhood achalasia.
- This surgical approach provides significant long-term symptomatic relief and supports weight gain.
- The procedure is recommended for managing pediatric achalasia.
Abstract:
Childhood achalasia is an uncommon condition characterised by the absence of oesophageal peristalsis together with increased resting pressure and failure of relaxation of the lower oesophageal sphincter. The currently accepted management is a modified Heller's cardiomyotomy with Nissen fundoplication; however, the long-term results are uncertain. A retrospective review of the notes of 10 children undergoing surgical treatment of achalasia at our institution over a 23-year period were reviewed. There were six boys and four girls. The median age at onset of symptoms was 123 months and at diagnosis was 133 months. Five children were below average weight at the time of presentation. All underwent a modified Heller's operation and Nissen fundoplication. The follow-up ranged from 12 to 277 months with a mean of nearly 10 years. The results were excellent in terms of symptomatic improvement in eight of ten with one good and one moderate outcome. All children below average weight have shown improvement postoperatively. We would conclude that the management of achalasia in childhood should consist of an extended Heller's cardiomyotomy performed by the abdominal approach with the addition of an antireflux procedure such as Nissen fundoplication.