Tie the guide wire to the silk sutures holding the removed skin so that it won't dislodged during dissection. Using a needle tip cautery and keeping traction on the tied skin-wire dissect the tract staying as near as possible to the fistulous tract until it can be safely removed. Occasionally a second stepladder incision in the neck will be required depending on the length of the tract. Esophago-Myotomy for Achalasia Achalasia in children is an uncommon esophageal motor disorder distinguished by clinical, radiological and manometric features. Clinical presentation is characterized by progressive dysphagia, regurgitation, weight loss, chest pain and nocturnal cough.
Diagnosis is established by barium swallow and confirmed by manometry and motility studies.
I prefer to do the esophagomyotomy through the abdomen. Children above the age of four benefit from a midline upper incision. Below that age a transverse supra-umbilical incision gives better exposure, safer closure, and good cosmetic results. A 16-G foley catheter is threaded through the gastrostomy into the distal esophagus and once in the thoracic esophagus the balloon is inflated. The foley is slowly brought toward the stomach, the balloon will hold in the stenotic part of the distal esophagus.