title: Robot-assisted Heller's myotomy for achalasia in children.
abstract: 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).
  
  
  CONCLUSIONS
  Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.
authors.affiliation: a Department of Surgery , College of Medicine and King Saud University Medical City, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Tariq
authors.initials: T
authors.lastname: Altokhais
authors.affiliation: b Department of Surgery , Security Forces Hospital , Riyadh , Saudi Arabia.
authors.forename: Hala
authors.initials: H
authors.lastname: Mandora
authors.affiliation: a Department of Surgery , College of Medicine and King Saud University Medical City, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Ayed
authors.initials: A
authors.lastname: Al-Qahtani
authors.affiliation: a Department of Surgery , College of Medicine and King Saud University Medical City, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Al-Bassam
mesh_terms: D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D000074434:Heller Myotomy; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D065287:Robotic Surgical Procedures / Q000379:methods*; D012529:Saudi Arabia; D016896:Treatment Outcome
keywords: Heller's myotomy; Robot-assisted; achalasia; children; robotics