Laparoscopic esophagomyotomy in children: is routine fundoplication necessary?

Abstract

Purpose Laparoscopic esophagomyotomy (LE) with or without fundoplication has been described as a modality for the treatment of achalasia in children. Our aim is to evaluate the safety and efficacy of LE without fundoplication in the management of achalasia in children.
Patients and methods A retrospective review of the medical record was carried out on patients with achalasia at our institution from January 2006 to March 2011. Eight children were diagnosed with esophageal achalasia and all of them underwent LE without fundoplication. These patients were reviewed to evaluate intraoperative and postoperative complications, as well as outcome.
Results Eight children with achalasia had LE without fundoplication successfully completed. There were four boys and four girls ranging in age between 1 and 13 years (mean 4.3 years). None of the patients had received therapy before LE. The mean operating time was 44 min. The mean follow-up was 40.3 months (range 6–62 months). There were no intraoperative or postoperative esophageal perforations or complications. The mean length of hospital stay was 2.7 days. None of the patients required redo esophagomyotomy or esophageal dilatation. Dysphagia symptoms improved uniformly and gastroesophageal reflux symptoms were not evident in follow-up.
Conclusion This technique of LE without fundoplication in the treatment of achalasia is safe, effective, and yields excellent cosmetic results. The routine addition of fundoplication to LE for the treatment of achalasia in our series appears to be unnecessary. Yet, a multicenter study with a large group of patients should be carried out. 

Keywords: achalasia, fundoplication for achalasia, laparoscopic esophagomyotomy