Laparoscopic and Thoracoscopic Esophagomyotomy for Children With Achalasia

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 33; no. 4; pp. 466 - 471
• Main Authors: Mehra, M, Bahar, R J, Ament, M E, Waldhausen, J, Gershman, G, Georgeson, K, Fox, V, Fishman, S, Werlin, S, Sato, T, Hill, I, Tolia, V, Atkinson, J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-10-2001; Lippincott
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Esophageal Achalasia - surgery; Esophagus; Esophagus - surgery; Female; Follow-Up Studies; Fundoplication; Humans; Intraoperative Complications; Laparoscopy - methods; Length of Stay; Male; Medical sciences; Minimally Invasive Surgical Procedures; Postoperative Complications; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracoscopy - methods; Treatment Outcome; Human; Postoperative; Multicenter study; Myotomy; Esophageal disease; Minimal realization; Congenital disease; Esophagus; Esophagoscopy; Malformation; Efficiency; Digestive diseases; Achalasia; Endoscopy; Safety; Technique; Child; Thoracoscopy
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/00005176-200110000-00009

BACKGROUNDMinimally invasive esophagomyotomy, consisting of a laparoscopic or thoracoscopic approach, has become a preferred surgical treatment for adults with achalasia. This multicenter study reports on the clinical status of children who have undergone minimally invasive esophagomyotomy for achalasia.
METHODSSymptomatology for achalasia was assessed in 22 pediatric patients who underwent minimally invasive esophagomyotomy for achalasia between 1995 and 2000. All patients were evaluated for duration of hospitalization, postoperative resumption of feeds, postoperative complications, and symptomatic relief. Participants were assigned pre-and postoperative symptom severity scores ranging from 0 (no symptoms) to 3 (severe).
RESULTSThe median age of the 10 females and 12 males at time of surgery was 11.3 years ± 3.4 (standard deviation). Transabdominal laparoscopic esophagomyotomy with fundoplication was performed in 18 patients, and thoracoscopic esophagomyotomy without fundoplication was performed in 4. Two patients required conversion from transabdominal laparoscopic esophagomyotomy to open esophagomyotomy because of intraoperative esophageal perforation. The mean duration of postsurgical follow-up was 17 ± 16 (standard deviation) months (range, 1–54 months). Mean duration of hospitalization (days ± standard error or mean) was less for transabdominal laparoscopic esophagomyotomy than for converted open esophagomyotomy (2.7 ± 0.3 vs. 9.0 ± 3.0 days;P < 0.05) or for thoracoscopic esophagomyotomy (4.8 ± 1.7 days;P = not significant). Mean time to resumption of soft feedings (days ± standard error or mean) occurred sooner after transabdominal laparoscopic esophagomyotomy than after converted open esophagomyotomy (2.0 ± 0.2 vs. 5.5 ± 0.5 days;P < 0.001) or after thoracoscopic esophagomyotomy (4.0 ± 1.3 days;P = not significant). Patients experienced significant pre-to postoperative improvement in mean severity score with regard to dysphagia (2.6 vs. 0.4;P < 0.001) and regurgitation (1.7 vs. 0.2;P < 0.001).
CONCLUSIONSMinimally invasive esophagomyotomy can provide excellent symptomatic relief from dysphagia and regurgitation for children with achalasia.