Published online Jan 25, 2016. doi: 10.4253/wjge.v8.i2.56
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
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.