Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

Luca Provenzano; Rebecca Pulvirenti; Miriam Duci; Giovanni Capovilla; Andrea Costantini; Francesca Forattini; Piergiorgio Gamba; Mario Costantini; Francesco Fascetti-Leon; enato Salvador

doi:10.1055/s-0043-1760822

European Journal of Pediatric Surgery, Inhaltsverzeichnis

Eur J Pediatr Surg 2023; 33(06): 493-498
DOI: 10.1055/s-0043-1760822

Original Article

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

Autor*innen

Luca Provenzano

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
Rebecca Pulvirenti

²Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
Miriam Duci

²Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
Giovanni Capovilla

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
Andrea Costantini

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
Francesca Forattini

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
Piergiorgio Gamba

²Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
Mario Costantini

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
Francesco Fascetti-Leon

²Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
enato Salvador

¹Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy

Abstract

Background Esophageal achalasia (EA) is a rare primary motility disorder in any age group, and particularly rare in the pediatric population, with a reported incidence of 0.18 per 100,000 children a year. EA in pediatric age is currently treated in the same way as in adults, but this approach is based on only a few studies on small case series. The aim of this retrospective study was to assess the long-term outcome of the laparoscopic Heller–Dor (LHD) procedure when performed in pediatric patients with EA at our university hospital.

Materials and Methods We considered children and adolescents younger than 16 years old diagnosed with EA and treated with LHD between 1996 and 2022. Clinical data were prospectively collected in an ongoing database. Symptoms were recorded and their severity was calculated using the Eckardt score. Barium swallow, esophageal manometry (conventional or high-resolution), and endoscopy were performed before and after the surgical procedure.

Results During the study period, 40 children with a median age of 14 years (interquartile range [IQR]: 11–15) underwent LHD. At a median follow-up of 10.5 years (IQR: 4.5–13.9), a good outcome was achieved in 36/40 patients (90%). Two of the four patients whose surgical procedure failed underwent complementary pneumatic dilations successfully, thus increasing the overall success rate to 95%. A previous endoscopic treatment (in five patients) did not affect the final outcome (p = 0.49). An intraoperative mucosal lesion was detected in only one patient (2.5%) and was repaired at the time without further consequences. During the follow-up, 22 patients underwent endoscopy, and 17 had pH monitoring as well: only 2 of these patients showed reflux esophagitis at endoscopy (one of them with abnormal findings on pH monitoring), amounting to a 9.1% rate of instrumentally confirmed postoperative reflux.

Conclusion LHD is a safe and persistently effective treatment for EA in pediatric age, with a success rate comparable with what is usually obtained in adults, and better than what has been reported to date in the pediatric literature. Adding a fundoplication certainly helps ensure an optimal long-term control of any gastroesophageal reflux induced by the myotomy.

Keywords

esophageal achalasia - Heller myotomy - fundoplication - children

Volltext

Referenzen

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