Garzi A, Prestipino M, Rubino M S, Calabrò E
Division of Pediatric M.I.S. and Robotic Surgery University of Salerno, Italy.
Division of Pediatric Surgery A.O. S. Maria della Misericordia Perugia, Italy.
Transl Med UniSa. 2020 May 31;22:38-43. eCollection 2020 May.
The Authors present a retrospective review of their record of cases, characterized by 4 cases of achalasia in which it was performed a Heller myotomy with front fundoplication (Thall) in laparoscopic approach in the period from 2012 to 2019. In paediatric achalasia, the laparoscopic Heller myotomy seems to be the best treatment because of its multiple advantages offered by the minimally invasive technique. First of all, thanks to the video-technique, which allows a complete and extended myotomy, the accuracy of this operation is maximized; moreover, the post-operative pain is widely reduced, thanks to the minimal dissection and traction of the tissues; finally, but not negligible, this approach ensures a better aesthetic result than the classic open technique. With regard to the front fundoplication, the Authors suggest that it is mandatory because, even if it extends the operating time, it ensures a natural protection to the myotomy herniated mucosa and avoids gastro-oesophageal reflux, which often occurs after the surgical correction, thus obliging to perform a reoperation.
作者对其病例记录进行了回顾性研究，该研究涵盖了2012年至2019年期间以腹腔镜方式进行的4例贲门失弛缓症患者，均接受了Heller肌切开术加前位胃底折叠术（Thall术式）。在小儿贲门失弛缓症中，腹腔镜Heller肌切开术似乎是最佳治疗方法，因为微创技术具有多种优势。首先，得益于视频技术，可实现完整且广泛的肌切开术，从而使该手术的准确性最大化；此外，由于组织的最小化剥离和牵拉，术后疼痛大幅减轻；最后但并非微不足道的是，这种方法比传统开放技术能确保更好的美学效果。关于前位胃底折叠术，作者认为这是必要的，因为即使它会延长手术时间，但能对肌切开处的疝出黏膜起到自然保护作用，并避免手术矫正后常出现的胃食管反流，否则往往需再次手术。
