Skip to main content

Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience

A retrospective review of the results of laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure in children with achalasia

Surgical Endoscopy volume 24, pages 40–44 (2010)Cite this article

Abstract

Background

Oesophageal achalasia is a rare disorder in childhood. Common treatments in adults include oesophageal cardiomyotomy (laparoscopic or open) with fundoplication. We aimed to assess the results of laparoscopic oesophageal cardiomyotomy without fundoplication for treatment of achalasia in children.

Methods

We reviewed the results of laparoscopic oesophageal cardiomyotomy between January 1998 and June 2008. Patients below the age of 18 years, who had undergone laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure by a single surgeon, were identified. Data were collected from patient notes. Results are reported as median (range).

Results

There were 20 patients (13 males and 7 females). Median age at surgery was 12 years (5–15 years) and weight was 38 kg (15–53 kg). Median duration of symptoms before surgery was 2.4 years (1.5–5 years). Duration of surgery was 96 min (60–160 min). Four patients (20%) required conversion to the open technique. In the remaining 16 children, fluids were started at a median of 7 h (6–8 h) post-operatively, and solid feeds were commenced at 22 h (20–24 h). Median length of hospital stay was 3 days (1–5 days). Median length of follow-up was 60 months (8–114 months). None of the patients had evidence of gastro-oesophageal reflux post-operatively. Five patients (25%) continued to experience dysphagia, with one of them also experiencing vomiting. Two patients were found to have oesophageal stricture and three patients were found to have oesophageal dysmotility. The remaining patients are asymptomatic.

Conclusions

These results suggest that laparoscopic oesophageal cardiomyotomy is a valid treatment in children with achalasia. In our experience, an adjunctive anti-reflux procedure is not required, as there was no evidence of post-operative gastro-oesophageal reflux in all patients. Oesophageal stricture and dysmotility account for residual post-operative symptoms.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Hurwitz M, Bahar RJ, Ament ME, Tolia V, Molleston J, Reinstein LJ, Walton JM, Erhart N, Wasserman D, Justinich C, Vargas J (2000) Evaluation of the use of botulinum toxin in children with achalasia. J Pediatr Gastroenterol Nutr 30:509–514

    Article  CAS  PubMed  Google Scholar 

  2. Ip KS, Cameron DJ, Catto-Smith AG, Hardikar W (2000) Botulinum toxin for achalasia in children. J Gastroenterol Hepatol 15:1100–1104

    Article  CAS  PubMed  Google Scholar 

  3. Anselmino M, Perdikis G, Hinder RA, Polishuk PV, Wilson P, Terry JD, Lanspa SJ (1997) Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg 132:233–240

    CAS  PubMed  Google Scholar 

  4. Csendes A, Braghetto I, Henriquez A, Cortes C (1989) Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 30:299–304

    Article  CAS  PubMed  Google Scholar 

  5. Patti MG, Fisichella PM, Perretta S, Galvani C, Gorodner MV, Robinson T, Way LW (2003) Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg 196:698–703

    Article  PubMed  Google Scholar 

  6. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  PubMed  Google Scholar 

  7. Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A (1992) Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 127:222–226

    CAS  PubMed  Google Scholar 

  8. Paidas C, Cowgill SM, Boyle R, Al-Saadi S, Villadolid D, Rosemurgy AS (2007) Laparoscopic Heller myotomy with anterior fundoplication ameliorates symptoms of achalasia in pediatric patients. J Am Coll Surg 204:977–983

    Article  PubMed  Google Scholar 

  9. Patti MG, Albanese CT, Holcomb GWIII, Molena D, Fisichella PM, Perretta S, Way LW (2001) Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. J Pediatr Surg 36:1248–1251

    Article  CAS  PubMed  Google Scholar 

  10. Rosati R, Fumagalli U, Bona S, Bonavina L, Pagani M, Peracchia A (1998) Evaluating results of laparoscopic surgery for esophageal achalasia. Surg Endosc 12:270–273

    Article  CAS  PubMed  Google Scholar 

  11. Soot SJ, Eshraghi N, Farahmand M, Sheppard BC, Deveney CW (1999) Transition from open to laparoscopic fundoplication: the learning curve. Arch Surg 134:278–281

    Article  CAS  PubMed  Google Scholar 

  12. Watson DI, Baigrie RJ, Jamieson GG (1996) A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? Ann Surg 224:198–203

    Article  CAS  PubMed  Google Scholar 

  13. Roller JE, de la Fuente SG, Demaria EJ, Pryor AD (2009) Laparoscopic Heller myotomy using hook electrocautery: a safe, simple, and inexpensive alternative. Surg Endosc 23:602–605

    Article  PubMed  Google Scholar 

  14. Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248:986–993

    Article  PubMed  Google Scholar 

  15. Karnak I, Senocak ME, Tanyel FC, Buyukpamukcu N (2001) Achalasia in childhood: surgical treatment and outcome. Eur J Pediatr Surg 11:223–229

    Article  CAS  PubMed  Google Scholar 

  16. Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, Izzo D, Russo F, Pizza F, del GG, del GA (2005) A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg 241:614–621

  17. Richards WO, Clements RH, Wang PC, Lind CD, Mertz H, Ladipo JK, Holzman MD, Sharp KW (1999) Prevalence of gastroesophageal reflux after laparoscopic Heller myotomy. Surg Endosc 13:1010–1014

    Article  CAS  PubMed  Google Scholar 

  18. Wang PC, Sharp KW, Holzman MD, Clements RH, Holcomb GW, Richards WO (1998) The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia. Am Surg 64:515–520

    CAS  PubMed  Google Scholar 

  19. Robert M, Poncet G, Mion F, Boulez J (2008) Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia. Monocentric prospective study of 106 cases. Surg Endosc 22:866–874

    Article  CAS  PubMed  Google Scholar 

  20. Gayet B, Fekete F (1991) Surgical management of failed esophagomyotomy (Heller’s operation). Hepatogastroenterology 38:488–492

    CAS  PubMed  Google Scholar 

  21. Pellegrini CA, Leichter R, Patti M, Somberg K, Ostroff JW, Way L (1993) Thoracoscopic esophageal myotomy in the treatment of achalasia. Ann Thorac Surg 56:680–682

    CAS  PubMed  Article  Google Scholar 

  22. Stipa S, Fegiz G, Iascone C, Paolini A, Moraldi A, De Marchi C, Chieco PA (1990) Heller–Belsey and Heller–Nissen operations for achalasia of the esophagus. Surg Gynecol Obstet 170:212–216

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW9-10NH, UK

    Larisa Corda, Maurizio Pacilli, Simon Clarke & Munther Haddad

  2. Gastroenterology Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

    John M. Fell & David Rawat

Authors
  1. Larisa Corda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maurizio Pacilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John M. Fell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Rawat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Munther Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Munther Haddad.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Corda, L., Pacilli, M., Clarke, S. et al. Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience. Surg Endosc 24, 40–44 (2010). https://doi.org/10.1007/s00464-009-0513-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0513-4

Keywords

  • Oesophageal achalasia
  • Fundoplication
  • Gastro-oesophageal reflux
  • Oesophageal cardiomyotomy
  • Heller’s myotomy