Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Table 1 Patient demographics

	Mean
Gender
Female	13	54%
Male	11	46%
Age of diagnosis	11	5-18
Duration of symptoms	2.8 years	1-11 years
Presenting symptoms	n	Percentage
Dysphagia	20	83%
Emesis	14	58%
Weight loss	11	46%
Chest pain	10	42%
Regurgitation	4	17%
Odynophagia	2	8%

Table 2 Surgical approach

	Mean
Age at surgery	12.9	5-8
OR time	124 min	45-213 min
LOS	2.7 d	1-6 d
Follow up	3.5 mo	1-12 mo
	n	Percentage
LHM	3	12.50%
LHM + TF	2	8.30%
LHM + DF	19	79.20%

LOS: Length of stay; LHM: Laparoscopic Heller myotomy; TF: Thal fundoplication; DF: Dor fundoplication.

Table 3 Surgical management of pediatric achalasia

Ref.	n	Age (yr)	Symptom duration (mo)	Procedure	OR time (min)	Complications	Treatment	Length of stay (d)	Follow up (mo)
Pastor et al[16]	40	12.4	10.7	6 OHM	186	1 perforation	Sutured	-	75
				3 LHM	156	2 perforations	Sutured	-
				11 LHM + Nissen
				21 dilation
Corda et al[24]	20	12	24	20 LHM	96	4 conversions OHM		3	60
		(5-15)			(60-160)	5 dysphagia		(1-5)
							1 lap LOA 1 redo LHM 1 redo OHM
Esposito et al[26]	31	8.4	>12	31 LHM/Dor	120	3 perforations	2 sutured	4	9-156
		(5-15)					1 redo HM	(3-8)
						5 dysphagia	2 dilated
							1 redo OHM
Tannuri et al[27]	15	12	30	15 LHM/Dor	90	2 dysphagia	1 botox injection	2.5	32.5
		(9-17)			(150-260)			(1-4)	(2-96)
Patti et al[28]	13	15	24	13 LHM/Dor	144 ± 35	-	-	2	19
		(6-17)
Lelli et al[29]	19	10	-	14 OHM	-	2 dysphagia	2 dilation	8	108
		(1-17)		5 OHM + Belsey					(6-252)
Rothenberg et al[30]	9	12	6-24	4 THM	95	1 perforation	Sutured	2	-
		(5-17)				1 dysphagia	Redo LHM
						2 GERD	Medical Rx
				5 LHM/Dor	62	1 delayed perforation	Lap repair	1
Askegard-Giesmann et al[31]	26	15	-	1 LHM	-	1 perforation	Sutured	2.7	0-75
		(4-18)		2 LHM/Dor		1 perforation/aspiration	Sutured	(1-4)	-20
						7 dysphagia
				23 LHM + Toupet			3 redo LHM
							3 dilation
						1 GERD	1 botox
							Medical Rx
Esposito et al[32]	8	6.3	> 121 LHM	6 LHM/Dor	120	3 perforations	3 sutured	4 (3-31)	6-60
		(2-13)		2 LHM/Thal	(90-150)
Current Study	24	12.9	> 24	3 LHM	124	2 perforations	2 sutured	2.7	4
		(5-18)		2 LHM/Thal	(45-213)			(1-6)	(4-24)
				19 LHM/Dor		2 dysphagia	2 dilations
							1 redo LHM

OHM: Open Heller myotomy; LHM: Laparoscopic Heller myotomy; THM: Thoracosopic Heller myotomy; Rx: Therapy.