{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T10:25:07Z","timestamp":1781346307910,"version":"3.54.1"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Esophageal achalasia (EA) is a rare primary motility disorder in any age group, and particularly rare in the pediatric population, with a reported incidence of 0.18 per 100,000 children a year. EA in pediatric age is currently treated in the same way as in adults, but this approach is based on only a few studies on small case series. The aim of this retrospective study was to assess the long-term outcome of the laparoscopic Heller\u2013Dor (LHD) procedure when performed in pediatric patients with EA at our university hospital.<\/jats:p><jats:p>Materials and Methods\u2003We considered children and adolescents younger than 16 years old diagnosed with EA and treated with LHD between 1996 and 2022. Clinical data were prospectively collected in an ongoing database. Symptoms were recorded and their severity was calculated using the Eckardt score. Barium swallow, esophageal manometry (conventional or high-resolution), and endoscopy were performed before and after the surgical procedure.<\/jats:p><jats:p>Results\u2003During the study period, 40 children with a median age of 14 years (interquartile range [IQR]: 11\u201315) underwent LHD. At a median follow-up of 10.5 years (IQR: 4.5\u201313.9), a good outcome was achieved in 36\/40 patients (90%). Two of the four patients whose surgical procedure failed underwent complementary pneumatic dilations successfully, thus increasing the overall success rate to 95%. A previous endoscopic treatment (in five patients) did not affect the final outcome (p\u2009=\u20090.49). An intraoperative mucosal lesion was detected in only one patient (2.5%) and was repaired at the time without further consequences. During the follow-up, 22 patients underwent endoscopy, and 17 had pH monitoring as well: only 2 of these patients showed reflux esophagitis at endoscopy (one of them with abnormal findings on pH monitoring), amounting to a 9.1% rate of instrumentally confirmed postoperative reflux.<\/jats:p><jats:p>Conclusion\u2003LHD is a safe and persistently effective treatment for EA in pediatric age, with a success rate comparable with what is usually obtained in adults, and better than what has been reported to date in the pediatric literature. Adding a fundoplication certainly helps ensure an optimal long-term control of any gastroesophageal reflux induced by the myotomy.<\/jats:p>","DOI":"10.1055\/s-0043-1760822","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T23:45:23Z","timestamp":1675208723000},"page":"493-498","source":"Crossref","is-referenced-by-count":5,"title":["Laparoscopic Heller\u2013Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center"],"prefix":"10.1055","volume":"33","author":[{"given":"Luca","family":"Provenzano","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Pulvirenti","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Duci","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Capovilla","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Forattini","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio","family":"Gamba","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fascetti-Leon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Women's and Children's Health, University of Padova, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"enato","family":"Salvador","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0140-6736(13)60651-0","article-title":"Achalasia","volume":"383","author":"G E Boeckxstaens","year":"2014","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1136\/adc.2009.171975","article-title":"UK incidence of achalasia: an 11-year national epidemiological study","volume":"96","author":"M Marlais","year":"2010","journal-title":"Arch Dis Child"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4253\/wjge.v6.i4.105","article-title":"Childhood achalasia: a comprehensive review of disease, diagnosis and therapeutic management","volume":"6","author":"A L Franklin","year":"2014","journal-title":"World J Gastrointest Endosc"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.4253\/wjge.v8.i2.56","article-title":"Laparoscopic esophagomyotomy for achalasia in children: a review","volume":"8","author":"T K Pandian","year":"2016","journal-title":"World J Gastrointest Endosc"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1093\/hmg\/10.3.283","article-title":"Triple A syndrome is caused by mutations in AAAS, a new WD-repeat protein gene","volume":"10","author":"K Handschug","year":"2001","journal-title":"Hum Mol Genet"},{"issue":"17","key":"ref6","doi-asserted-by":"crossref","first-page":"3917","DOI":"10.3390\/jcm10173917","article-title":"Achalasia in children - 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