Paediatric laparoscopic Heller’s cardiomyotomy: A single centre series

Pachl, Max; Rex, Dean; Coppi, Paolo De; Cross, Kate; Kiely, Edward M.; Drake, David; Pierro, Agostino; Curry, Joe

doi:10.1016/j.jpedsurg.2013.11.042

Cited by 21 publications

(16 citation statements)

References 23 publications

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“…[2][3][4][5] Controversy still exists concerning which treatment option is the best due to the rarity of the disease in children, the presence of multiple treatment modalities and a lack of randomized controlled studies in this age group. [12] Despite the lack of a definite conclusion, advances and refinements in laparoscopy in pediatrics, a low rate of complications, a high rate of success and faster recovery have shifted the treatment preference toward laparoscopic Heller's myotomy. [13] Most studies in children have supported using surgical Heller's myotomy for long-term outcomes since the introduction of minimal surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29] An anti-reflux procedure significantly reduces the risk of gastroesophageal reflux but increases the risk of dysphagia, and the debate continues on which symptom is easier to manage the reflux or the dysphagia. [12,[26][27] Authors, who believe that the management of dysphagia in children is easier, especially with dilatations, do not support a concomitant anti-reflux procedure. Other authors who believe that there is a significant rate of reflux advocate for fundoplication.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors who believe that there is a significant rate of reflux advocate for fundoplication. [12,[26][27] Because dysphagia commonly occurs postmyotomy, an algorithm was proposed to address postHeller's myotomy dysphagia. [30] Identification of the ideal anti-reflux procedure in children is still controversial, but both Dor and Toupet fundoplication techniques showed similar results.…”

Section: Discussionmentioning

confidence: 99%

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Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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“…However post-operative intervention (including balloon dilatation and redo myotomy) was required in 28% of patients on subsequent follow-up. 17 Similarly, the recurrence of symptoms after LHM with fundoplication was 27 % at a mean follow-up of 13 months in another series. 18 Early and durable treatment is especially important in the pediatric population as treatment failure may lead to malnutrition and growth failure.…”

Section: Discussionmentioning

confidence: 82%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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Background/AimsAchalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia MethodsThe data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3. ResultsA total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6). Conclusions

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“…Well-established methods include endoscopic balloon dilatation, Heller’s myotomy and botulinum injections [1]. Recent reports also mention per oral endoscopic myotomy (POEM) [2] and esophageal stenting [3].…”

Section: Introductionmentioning

confidence: 99%

Pediatric achalasia. Single-center study of interventional treatment

Grabowski

Korlacki

Pasierbek

et al. 2017

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IntroductionEsophageal achalasia is a rare entity in children. However, young age is a factor of failure of conservative treatment, emphasizing the role of surgery. In our institution laparoscopic Heller’s cardiomyotomy is the chosen procedure for surgical treatment.AimTo assess the outcome of surgery for achalasia treatment in children operated on in a single institution.Material and methodsA retrospective analysis of consecutive patient records from the years 1997 to 2014 was performed. There were 11 patients. Their mean age was 13 years, ranging from 6 to 17. Duration of symptoms was 2 to 36 months, mean 16. All 11 patients were operated on with a laparoscopic approach. Pneumatic dilatation was used both pre- and postoperatively but in no case was sufficient on its own. Collected data included patient demographics, preoperative symptoms and their duration, diagnostic findings and therapeutic means. Surgical procedures, complications and long-term follow-up were analyzed. The follow-up lasted from 1 to 10 years and finished when the patient reached 18 years of age.ResultsTwelve laparoscopic cardiomyotomies were performed with concomitant fundoplications, 10 Toupet and 2 Dor and one redo procedure. There were no deaths. Two perforations were repaired promptly. The success rate was 82%, though with subsequent dilatations. One failure was due to serious progression of the disease.ConclusionsIn our opinion, laparoscopic Heller’s myotomy is the procedure of choice for treating achalasia in children. Endoscopic balloon dilatation may be used as a complementary treatment, especially as a primary redo procedure.

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Paediatric laparoscopic Heller’s cardiomyotomy: A single centre series

Cited by 21 publications

References 23 publications

Robot-assisted Heller’s myotomy for achalasia in children

Robot-assisted Heller’s myotomy for achalasia in children

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Pediatric achalasia. Single-center study of interventional treatment

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