The surgical approach to oesophageal achalasia

The term 'oesophageal achalasia' describes a neuropathic disorder characterized by abnormal motility of the oesophagus and incomplete or absent relaxation of the lower oesophageal sphincter. In these patients with 'paroxysmal' dysphagia, barium swallow and manometric study confirm the diagnosis. In our opinion, the treatment of choice is extramucosal cardiomyotomy (Heller) which should be followed by gastric fundoplication in order to protect the mucosa and prevent gastrooesophageal reflux. We present our experience in the laparoscopic approach to Heller cardiomyotomy in children. An anterior 180°hemi-fundoplication, according to Dor technique, is performed suturing the left and right oesophageal muscular margin to the gastric wrap. A manometric examination is mandatory in order to detect the complete incision of the lower oesophageal sphincter and to confirm the creation of the new-high pressure zone. This preliminary experience confirms that the laparoscopic approach can be used for the treatment of oesophageal achalasia also in children.