Robot-assisted Heller myotomy in the treatment of achalasia in children

Abstract

BACKGROUND: Esophageal achalasia in children is a rare disease. Heller myotomy combined with Dor fundoplication remains the treatment of choice for this disease. Surgical interventions include open, laparoscopic and robotic approaches. This article describes the first experience of Heller robot-assisted myotome in a child. It also presents a literature review on this topic.

CLINICAL CASE DESCRIPTION: The authors present retrospective data of a 10-year-old adolescent boy who was operated on for esophageal achalasia with the robot-assisted approach. The patient was admitted to the surgical department of Irkutsk State Regional Children's Clinical Hospital in satisfactory condition with complaints of dysphagia, frequent regurgitation after meals, and delayed weight gain. The diagnosis of cardia achalasia was put after contrast examination of the esophagus and after endoscopic examination of the upper gastrointestinal tract and after esophageal manometry. Heller robot-assisted myotomy was performed with surgical robot Versius (manufactured by CMR, UK). Patient's weight was 30 kg. His age was 10 years. This disease lasted for 3 years. Robot-assisted Heller myotomy was done in a minimally invasive manner without conversion to an open surgery. Total myotomy length was 7 cm; duration of surgical intervention — 125 minutes; duration of patient's stay in the hospital — 4 days; duration of follow-up — 4 months. In the late follow-up, no significant complications, like symptom recurrence or reflux, were seen.

CONCLUSION: Robotic-assisted Heller myotomy for esophageal achalasia in children is safe and effective technique. It is also good alternative to open and laparoscopic surgeries.

Keywords

esophageal achalasia / robot-assisted surgery / children

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