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

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.