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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

Luca Provenzano
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
,
Rebecca Pulvirenti
2   Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
,
Miriam Duci
2   Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
,
Giovanni Capovilla
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
,
Andrea Costantini
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
,
Francesca Forattini
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
,
Piergiorgio Gamba
2   Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
,
Mario Costantini
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
,
Francesco Fascetti-Leon
2   Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy
,
enato Salvador
1   Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
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Funding None.
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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


Publikationsverlauf

Eingereicht: 03. Oktober 2022

Angenommen: 29. November 2022

Artikel online veröffentlicht:
31. Januar 2023

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