Surgical treatment of achalasia in children: is an added antireflux procedure necessary?

Between 1975 and 1994, nine patients with achalasia were treated surgically at the Department of Pediatric Surgery, Ege University Hospital. The mean age was 8.3 years; there were 4 boys and 5 girls; and dysphagia was the leading symptom. There was also significant growth retardation in most of the patients. A modified Heller's myotomy was performed in all cases via a transthoracic approach without an antireflux procedure. In one patient the myotomy resulted in significant gastroesophageal reflux, but this could be controlled medically. This patient also needed esophageal balloon dilatation twice after the operation. Symptoms were relieved dramatically in the rest of the patients after surgery. We conclude that an additional antireflux procedure need only be performed when the esophagomyotomy is done incorrectly (an unnecessarily long incision extended onto the stomach), but is otherwise unnecessary.