Esophageal

Background/Purpose: In the past, surgical treatment in acha-lasia usually has been reserved for patients whose dyspha-gia does not respond to pneumatic dilatation. The success of minimally invasive myotomy, however, has resulted in a shift in practice in adult patients, whereby laparoscopic sur-gery is becoming preferred as primary treatment by most gastroenterologists and surgeons. The aim of this study was to assess the efficacy of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. Methods: Thirteen patients with esophageal achalasia (me-dian age, 15 years; 6 boys and 7 girls; median duration of symptoms, 24 months) underwent laparoscopic Heller my-otomy and Dor fundoplication between 1996 and 1999. Two patients had been treated previously by pneumatic dilata-tion, and 1 patient had received intrasphincteric Botulinum toxin injections. Results: Median duration of the operation was 130 minutes. The patients were fed after an average of 33 hours, and they all left the hospital within 2 days. At a median follow-up of 19 months, there was no residual dysphagia in any patient. Conclusions: Laparoscopic Heller myotomy and Dor fun-doplication were effective and safe for children with esoph-ageal achalasia. Hospital stay and recovery time was short, and the functional results were excellent. These data support the notion that laparoscopic Heller myotomy should become the primary treatment of esophageal achalasia in children