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

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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.

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About the authors

Yury A. Kozlov

Children's Regional Clinical Hospital; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X
SPIN-code: 3682-0832

MD, Cand. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Россия, 4 Gagarina boulevard, 664022 Irkutsk; Irkutsk; Irkutsk

Simon S. Poloyan

Children's Regional Clinical Hospital; Irkutsk State Medical University

Email: simonpoloyan@ya.ru
ORCID iD: 0000-0001-7042-6646

MD

Россия, 4 Gagarina boulevard, 664022 Irkutsk; Irkutsk

Eduard V. Sapukhin

Children's Regional Clinical Hospital

Email: sapukhin@yandex.ru
ORCID iD: 0000-0001-5470-7384

MD, Cand. Sci. (Medicine)

Россия, 4 Gagarina boulevard, 664022 Irkutsk

Alexey S. Strashinsky

Children's Regional Clinical Hospital

Email: strashinskiia.s@gmail.ru
ORCID iD: 0000-0002-1911-4468

MD

Россия, 4 Gagarina boulevard, 664022 Irkutsk

Marina V. Makarochkina

Children's Regional Clinical Hospital

Email: m.makarochkina@gmail.com
ORCID iD: 0000-0001-8295-6687
SPIN-code: 4600-4071

MD

Россия, 4 Gagarina boulevard, 664022 Irkutsk

Andrey A. Marchuk

Children's Regional Clinical Hospital

Author for correspondence.
Email: maa-ped20@yandex.ru
ORCID iD: 0000-0001-9767-0454

MD

Россия, 4 Gagarina boulevard, 664022 Irkutsk

Alexander P. Rozhanski

Irkutsk State Medical University

Email: alexanderozhanski@mail.ru
ORCID iD: 0000-0001-7922-7600
SPIN-code: 4012-7120

MD

Россия, Irkutsk

Anton A. Byrgazov

Children's Regional Clinical Hospital

Email: byrgazov.ant-doc38@yandex.ru
ORCID iD: 0000-0002-9195-5480

MD

Россия, 4 Gagarina boulevard, 664022 Irkutsk

Sergey A. Muravev

Irkutsk State Medical University

Email: muravev1999sergey@mail.ru
ORCID iD: 0000-0003-4731-7526

MD

Россия, Irkutsk

Artem N. Narkevich

South-Ural State Medical University; Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Email: narkevichart@gmail.com
ORCID iD: 0000-0002-1489-5058

MD

Россия, Chelyabinsk; Krasnoyarsk

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Supplementary files

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2. Fig. 1. Esophagography of the patient with esophageal achalasia.

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3. Fig. 2. Heller robot-assisted myotomy: the stage of longitudinal dissection of muscular layer of the esophagus.

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4. Fig. 3. Heller robot-assisted myotomy: Dor fundoplication stage (fixation of the lateral edge of the cuff).

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5. Fig. 4. Heller robot-assisted myotomy: Dor fundoplication stage (fixation of the medial edge of the cuff).

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Copyright (c) 2024 Kozlov Y.A., Poloyan S.S., Sapukhin E.V., Strashinsky A.S., Makarochkina M.V., Марчук А.А., Rozhanski A.P., Byrgazov A.A., Muravev S.A., Narkevich A.N.

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