WOFAPS 2025 8th World Congress of Pediatric Surgery

Abdumanap Alkhasov, Sergey Ratnikov, Elena Komina, Nikolay Shubin, Anna Shmikova

National Medical Research Center for Children’s Health Federal state autonomous institution of the Russian Federation Ministry of Health, Moscow, Russia

Relevance

In the world literature, the standard treatment for achalasia is balloon dilation of the cardia, and surgical treatment is secondary.

Materials and methods

A retrospective analysis of the results of surgical treatment of achalasia was performed in 27 children operated on in the surgical thoracic department 2019 - 2025. The average age is 12.5 ± 5.3 years. 16 (59.3%) patients had stage III achalasia, 11 (40.7%) - stage II. 8 patients (29.6%) had previously undergone surgical treatment (3 - cardiomyotomy/balloon dilation, 5 patients - dilation), in all patients the effect was short-term, relapse in 100% of cases. Radiography of the esophagus with contrast, fibroesophagogastroduodenoscopy, and the Eckardt scale were used for preoperative examination and evaluation the effectiveness of the treatment. All patients underwent laparoscopic Heller capdiomyotomy with Dor fundoplication

Results

All children achieved good results of surgical treatment, dysphagia and regurgitation were eliminated. After surgery 13 (48.1%) patients required a single balloon cardiodilation due to relapse of dysphagia. Triple balloon dilation was performed in 3 patients (11.1%) who had previously undergone surgical treatment at the place of residence. In all patients, a reduction in the size of the esophagus was noted during the control examination; in 12 (44.4%) patients, the diameter of the esophagus decreased to the age norm. After cardiomyotomy gastroesophageal reflux wasn't detected in the X-ray contrast study. A decrease in the total score on the Eckardt scale was noted after surgical treatment, which indicates the high efficiency of surgical treatment of achalasia using laparoscopic Heller cardiomyotomy and Dor fundoplication.

Conclusion

Methods of cardiodilation give a short-term effect and can only be used in addition to surgical treatment, laparoscopic Heller cardiomyotomy with Dor fundoplication allows to obtain a good treatment result, a significant improvement in the quality of life and can be considered as a standard of treatment in children.