title: Laparoscopic Heller myotomy with anterior fundoplication ameliorates symptoms of achalasia in pediatric patients.
abstract: BACKGROUND
  This study was undertaken to define outcomes after laparoscopic Heller myotomy with anterior fundoplication in pediatric patients and compare their outcomes with those in adults.
  
  
  METHODS
  A total of 337 patients have undergone laparoscopic Heller myotomy with anterior fundoplication since 1992, and were prospectively followed; 14 were pediatric patients of median age 17 years (range 11 to 19 years). Symptoms noted by pediatric patients before and after myotomy were compared with symptoms of 56 concurrently treated adults (4 treated adults for each pediatric patient) of median age 48 years. Among many symptoms, patients scored the severity and frequency of dysphagia, chest pain, regurgitation, choking, vomiting, and heartburn before and after myotomy using a Likert scale, ranging from 0 (never/not bothersome) to 10 (always/very bothersome). Followups were 38 months, 42 months+/-33.1. Data are reported as median, mean +/- SD.
  
  
  RESULTS
  For pediatric patients, length of stay after myotomy was 2 days, 3 days+/-2.9 versus 2 days, 2+/-2.1 for adults. Before myotomy, symptom frequency and severity were similar between groups. After myotomy, symptom frequency and severity were similar between pediatric and adult patients, except for the frequency of chest pain.
  
  
  CONCLUSIONS
  Achalasia can produce disabling symptoms, which were similar between pediatric and adult patients before myotomy. Laparoscopic Heller myotomy with anterior fundoplication ameliorated symptoms of achalasia in all patients, with postmyotomy symptoms similar between pediatric and adult patients. Laparoscopic Heller myotomy dramatically improved symptoms of achalasia in pediatric patients and its use is encouraged.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL 33606, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Paidas
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Cowgill
authors.forename: Robert
authors.initials: R
authors.lastname: Boyle
authors.forename: Sam
authors.initials: S
authors.lastname: Al-Saadi
authors.forename: Desiree
authors.initials: D
authors.lastname: Villadolid
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D016896:Treatment Outcome