Laparoscopic Heller’s cardiomyotomy and fundoplication; A successful approach for Achalasia Management at Muhimbili National Hospital, Tanzania: A cases series

Document Type : Case Reports

Authors

Department of Surgery- Gastroenterology Unit, Muhimbili National Hospital, Dar-es-salaam, Tanzania.

Abstract

Aims: To describe the surgical management and outcomes of pediatric achalasia in two patients with rare comorbidities, focusing on the challenges and limitations in a resource-limited setting.
Patients & Methods: This case series includes a 9-year-old male with Triple-A syndrome and a 7-year-old male with Addison’s disease, both presenting with long-standing dysphagia. Both patients underwent laparoscopic Heller’s myotomy and Dor fundoplication. The diagnosis was primarily based on clinical presentation and barium swallow due to the unavailability of esophageal manometry.
Results: Both patients demonstrated significant improvements in dysphagia postoperatively. No intraoperative complications occurred, and neither patient experienced recurrence or complications at follow-up. However, the lack of manometric studies may have affected diagnostic precision.
Conclusions: This case series highlights the effective use of laparoscopic Heller’s myotomy in pediatric achalasia patients with complex comorbidities. The absence of manometric studies and Per-Oral Endoscopic Myotomy options underscores the need for advanced diagnostic tools and surgical techniques in resource-limited settings.

Keywords

Footnotes. Editor’s note: We encourage publication from the African community despite the procedure being not entirely new but innovative for the authors and their patients. Sara Salem (lecturer of internal medicine) and Ahmed Gomaa (professor of internal medicine) were the peer reviewers. E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil, Amany Mohammed. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). It may be used, distributed, or reproduced in other forums, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal must be cited according to accepted academic practice.Disclaimer: The authors' claims in this article are solely their own and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethical approval: All procedures involving human participants followed the institutional and national research committee's moral standards, the 1964 Helsinki Declaration, and its later amendments or comparable ethical standards. All authors declare that consent was obtained from the patient (or other approved parties) to publish this study. Data and materials availability: The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Ethical approval This case report study was approved by ethical approval at our institution. Informed consent for publication Written consent was obtained from patients’ parents to publish their children’s cases. Funding: This study had no funding from any resource. This work was done according to the CARE guidelines. Authors’ contributions All authors thoroughly reviewed and approved the final version of the manuscript. Acknowledgment: We are grateful to the administration and surgical team at Muhimbili National Hospital for their invaluable support in successfully conducting these laparoscopic operations.

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