ABSTRACT
Achalasia is a motility disorder of the esophagus characterized by an absence of peristalsis and a failure of relaxation of the lower esophageal sphincter. The cardinal symptoms in childhood are vomiting, dysphagia, chest pains and recurrent respiratory infections, and weight loss. Transient relief of symptoms can be achieved with nifedipine, a calcium antagonist that reduces the pressure at the lower esophageal sphincter. Most patients with symptomatic achalasia are older than 10 years of age. A 180-degree anterior fundoplication is performed to prevent reflux and to protect the mucosa. Perforation of the mucosa during myotomy is rare and occurs mainly at the esophagogastric junction. Absorbable sutures are used to close the perforation site. Patients with missed or delayed perforation present with sepsis and symptoms of peritonitis or mediastinitis within 24–48 hours postoperatively. Long-term dysphagia may occasionally require balloon dilatation or repeat myotomy to deal with an incomplete myotomy or a too-tight fundoplication.
