title: Paediatric laparoscopic Heller's cardiomyotomy: a single centre series.
abstract: BACKGROUND
  The optimal management of oesophageal achalasia remains unclear in the paediatric population due to the rarity of the disease. This study reviews the institutional experience of the laparoscopic Heller's cardiomyotomy (HC) procedure and attempts to define the most appropriate treatment.
  
  
  METHODS
  A retrospective review of children undergoing HC at a single institution was performed. Demographics, pre-operative investigations, and interventions were reviewed. Post-operative outcomes and follow up were evaluated. Data is expressed as median (range).
  
  
  RESULTS
  Twenty-eight children were included (13 male, 15 female) whose median age was 13 (3.2-17.4) years. Nine children underwent a pre-operative oesophageal balloon dilatation (OBD) a median of 1(1-6) times. Others included botulinum toxin injection (n=1) and Nifedipine (n=1). All had a pre-operative upper gastrointestinal contrast series, and twenty-five had upper gastrointestinal endoscopy and manometry. All had laparoscopic HC with no conversions, and ten had a concomitant fundoplication. Post-operative intervention occurred in eight (28%) incorporating OBD (n=7), of whom four required a redo HC. One patient underwent a redo without intervening OBD. Follow-up was for a median of 0.83 (0-5) years with fourteen children discharged from surgical follow-up. Twenty-seven have thus far had a good outcome.
  
  
  CONCLUSIONS
  This study comprises the largest series of paediatric laparoscopic HC reported to date. It is effective with or without a fundoplication and is the best long term treatment modality available. OBD for persisting symptoms following HC may obviate the need for redo myotomy.
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Max J
authors: MJ
authors: Pachl
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Dean
authors: D
authors: Rex
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Paolo
authors: P
authors: Decoppi
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Kate
authors: K
authors: Cross
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Edward M
authors: EM
authors: Kiely
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: David
authors: D
authors: Drake
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors: Agostino
authors: A
authors: Pierro
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. Electronic address: joe.curry@gosh.nhs.uk.
authors: Joe I
authors: JI
authors: Curry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D018662:Fundoplication / Q000379:methods; D006801:Humans; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Children; Esophageal achalasia; Heller’s procedure; Laparoscopic