A novel technique for the surgical treatment of achalasia in children: evaluated with postoperative esophageal manometry.
BACKGROUND
The current surgical treatment for achalasia in the pediatric population is the laparoscopic Heller myotomy with or without a fundoplication. Although medical management with serial dilations and botulism toxin injections may offer short-term benefits, surgical therapy offers definitive treatment. In this article, we propose a modified surgical technique that avoids pitfalls associated with the standard procedure and evaluated our results with postoperative manometry.


METHODS
Charts were reviewed for all patients having undergone the proposed surgical procedure. Seven patients underwent postoperative manometry, while 12 answered a short questionnaire.


RESULTS
While manometry showed a statistically significant reduction of lower esophageal sphincter tone, from a mean preoperative lower esophageal sphincter (LES) of 56.1 mm Hg (SD = 8.88, 95% CI = 50.36-61.93) to mean postoperative LES tone of 11.69 mm Hg (SD = 11.69, 95% CI = 3.287-20.08; P < 0.0001), peristalsis was not consistently affected, although a trend toward improvement was noted. Symptoms related to dysphagia were noted in 42% of patients postoperatively but were mild, while all patients showed improved feeding tolerance and weight gain. Interestingly, patients with a postoperative LES pressure <12 mm Hg were more likely to have no symptoms, although this LES pressure was arbitrarily chosen and the study was not powered to detect this outcome (chi-square = 3.73, df = 1; P < 0.053).


CONCLUSIONS
The proposed surgical technique for the treatment of achalasia in children was successful at improving feeding and weight gain and attaining normal postoperative LES tone; however, underlying esophageal dysmotility persisted.
Logan
Melissa S
MS
Department of Surgery, The University of Virginia, Charlottesville, VA, USA.
Vossoughi
Faranak
F
Watson
Christopher M
CM
Amarnath
Rathna
R
Camps
Juan I
JI
D002648:Child; D015331:Cohort Studies; D004931:Esophageal Achalasia / Q000503:physiopathology* / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D009129:Muscle Tonus / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies