Pandian TK, Naik ND, Fahy AS, Arghami A, Farley DR, Ishitani MB, Moir CR. Laparoscopic esophagomyotomy for achalasia in children: A review. World J Gastrointest Endosc 2016; 8(2): 56-66 [PMID: 26839646 DOI: 10.4253/wjge.v8.i2.56]
Corresponding Author of This Article
David R Farley, MD, FACS, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. farley.david@mayo.edu
Research Domain of This Article
Surgery
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 25, 2016; 8(2): 56-66 Published online Jan 25, 2016. doi: 10.4253/wjge.v8.i2.56
Laparoscopic esophagomyotomy for achalasia in children: A review
T Kumar Pandian, Nimesh D Naik, Aodhnait S Fahy, Arman Arghami, David R Farley, Michael B Ishitani, Christopher R Moir
T Kumar Pandian, Nimesh D Naik, Aodhnait S Fahy, Arman Arghami, David R Farley, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Arman Arghami, Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Michael B Ishitani, Christopher R Moir, Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Pandian TK conceptualized the paper, conducted the literature search and content development; Naik ND, Fahy AS and Arghami A conducted the literature search and content development; Moir CR served as senior author and oversaw content development; all authors were involved in manuscript development and revision; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David R Farley, MD, FACS, Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. farley.david@mayo.edu
Telephone: +1-507-2842644 Fax: +1-507-2845196
Received: April 28, 2015 Peer-review started: May 6, 2015 First decision: September 8, 2015 Revised: September 28, 2015 Accepted: November 13, 2015 Article in press: November 17, 2015 Published online: January 25, 2016 Processing time: 266 Days and 10 Hours
Abstract
Esophageal achalasia in children is rare but ultimately requires endoscopic or surgical treatment. Historically, Heller esophagomyotomy has been recommended as the treatment of choice. The refinement of minimally invasive techniques has shifted the trend of treatment toward laparoscopic Heller myotomy (LHM) in adults and children with achalasia. A review of the available literature on LHM performed in patients < 18 years of age was conducted. The pediatric LHM experience is limited to one multi-institutional and several single-institutional retrospective studies. Available data suggest that LHM is safe and effective. There is a paucity of evidence on the need for and superiority of concurrent antireflux procedures. In addition, a more complete portrayal of complications and long-term (> 5 years) outcomes is needed. Due to the infrequency of achalasia in children, these characteristics are unlikely to be defined without collaboration between multiple pediatric surgery centers. The introduction of peroral endoscopic myotomy and single-incision techniques, continue the trend of innovative approaches that may eventually become the standard of care.
Core tip: Laparoscopic Heller myotomy (LHM) is safe and effective in the pediatric achalasia population. Published studies are limited by their retrospective nature and small sample sizes. Further information regarding the need for and type of concurrent fundoplication, a more complete description of complications, and long-term (> 5 years) outcomes is needed. Peroral endoscopic myotomy and the single-incision approach are innovative techniques that may eventually prove to be the standard of care. Herein, we review the available literature on LHM in children with achalasia.
