Department of Paediatric SurgerySri Ramachandra Medical College & RI

Porur, Chennai- 600116

Dr.R.M.Manoj kumar Dr .Deepak J.

Dr.P.Balamourougane Dr. R.Madhu

Dr. Prakash AgarwalProf. S.Balagopal

History

6 months /maleC/o feeding difficultyH/o vomiting immediately after taking feedsRecurrent respiratory tract infectionLoss of weightInvestigated outside

Examination

Weight 4 kgsVitals stableCvs: s1 s2 +Rs: bilateral air entry+, mild creps+P/A: soft,Bs+,no organomegaly no mass palpable

Investigation

Blood R/E: normalUrine R/E: normalRFT and Sr.Electrolytes: normalCoagulation profile: Normal

X ray chest

Pneumonic patch - ? aspiration

Barium swallow

Rat tail apperanance+

Diagnosis

Achalasia cardia

Procedure

Laparoscopic cardiomyotomy with Dor’s fundoplication

Position

Supine and cross table

24 F feeding tube inserted

Ports

Five 5mm ports -Umbilical –

camera -Hypogastric –

stomach retraction -Epigastric – liver retraction - Right and left

lumbar

Procedure

Post op

UneventfulStarted on feed on

day3No vomiting and

tolerated feeds wellDischarged on day5Sutures removed on

day 10

Follow up

Taking feeds wellWeight gain +

Conclusion

Advantages No scar Less morbidity Early recovery Shorter hospital stay Decreased period of immobility Shorter time to tolerating oral diet

Conclusion

Achalasia cardia is rare in infantsLaparoscopic cardiomyotomy in infant is

more demanding

References

Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity

Angkoolpakdeekul, Theerapol (T); Jakapark, Suriya (S); Journal of the Medical Association

of Thailand,Chotmaihet thangphaet (J Med Assoc Thai), 2007-May; vol 90 (issue 5) : pp

988-93.

ReferencesThe advent of laparoscopic cardiomyotomy,

performed through five small cuts on the abdominal wall and the added promise of long-term relief of dysphagia, has resurrected the role of surgery in the treatment of achalasia.

Laparoscopic cardiomyotomy has now become the treatment of choice for achalasia cardia all around the globe.

Laparoscopic treatment of Achalasia Cardia-S Sadhu, S Sarkar, J K Shah, S K Dubey, M

K Roy, Dept. of Surgery & MIS Healing TouchVol-3 No. 11December, 2005

References

1. Sweet MP, N. I., Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG. (2008). "The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation." J Gastrointest Surg. 12: 159-165.2. Jafri M, A. M., Kaul A, Dierig J, Racadio J, Inge T, Brown R, Ryckman F, Tiao G. (2008). "Intraoperative manometry during laparoscopic Heller myotomy improves outcome in pediatric achalasia." J Pediatr Surg. 43: 66-70.3. Lake JM, W. R. (2006). "Review article: the management of achalasia - a comparison of different treatment modalities." Aliment Pharmacol Ther. 24: 909-18.4. Ahmed., A. (2008). "Achalasia: what is the best treatment?" Ann Afr Med. 7: 141-8.5. Palanivelu C, M. G., Jani K, Parthasarthi R, Sendhilkumar K, Rangarajan M. (2007). "Minimally invasive management of achalasia cardia: results from a single center study." JSLS. 11: 350-7.6. Nomura T, M. M., Makino H, Okawa K, Iwakiri K, Tajiri T. (2008). "Usefulness of the laparoscopic Heller-Dor operation for esophageal achalasia: introducing the procedure to our institution." J Nippon Med Sch. 75: 207-11.7. Avtan L, A. C., Guvenc H, Igci A, Ozmen V (2005). "Laparoscopic myotomy for oesophageal achalasia--adding an antireflux procedure is not always necessary." Int J Clin Pract.59:35-8.8. Wang QS, L. L., Dong L, Shen ZL, Zhou DH, Hu CX. (2006). "Laparoscopic Heller-Dor operation for patients with achalasia." Chin Med J (Engl). 119: 443-7.9. Esposito C, M.-S. M., Roblot Maigret B, Amici G, Desruelle P, Montupet P. (2000). "Complications of laparoscopic treatment of esophageal achalasia in children." J Pediatr Surg. 35: 680-3. 

Thank you