Long-term results of laparoscopic treatment of esophageal achalasia in children: a multicentric survey.
BACKGROUND
This report describes three Italian centers' experience in the treatment of children with esophageal achalasia.


METHODS
Between June 2000 and June 2012, 31 children (13 girls and 18 boys, with a median age of 8.4 years) affected by esophageal achalasia were treated in three different institutions with an esophagomyotomy according to Heller's procedure via laparoscopy associated with a Dor antireflux procedure. Between 2000 and 2005 (for 14 patients) we used mono- or bipolar coagulation to perform myotomy; after 2005 (for 17 patients) we used the new hemostatic devices to perform it.


RESULTS
Median length of surgery was 120 minutes. Median hospital stay was 4 days. We recorded eight complications in our series: 3 patients (9.6%) had a mucosal perforation, and 5 children (16.1%) presented dysphagia after surgery. When comparing the data before and after 2005, it seems that the new hemostatic devices statistically shortened the length of surgery (P<.01, Student's t test).


CONCLUSIONS
On the basis of our experience, laparoscopic Heller's myotomy associated with an antireflux procedure is a safe and effective method for the treatment of achalasia in the pediatric population. Intraoperative complications were <10%, and they occurred mostly at the beginning of our experience. Residual dysphagia occurred in about 16% of cases. The use of the new hemostatic devices seems to reduce the length of surgery and intraoperative bleeding. Considering the rarity of this pathology, we believe that patients with achalasia have to be treated only at centers with a strong experience in the treatment of this pathology.
1 Department of Pediatrics, "Federico II" University of Naples , Naples, Italy .
Ciro
C
Esposito
Giovanna
G
Riccipetitoni
Salvatore Fabio
SF
Chiarenza
Agnese
A
Roberti
Claudio
C
Vella
Francesca
F
Alicchio
Giorgio
G
Fava
Maria
M
Escolino
Teresa
T
De Pascale
Alessandro
A
Settimi
D000367:Age Factors; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome