Myotomies

A myotomy is a surgical procedure that involves cutting through muscle fibers to relieve abnormal constriction or spasm. By weakening or releasing a contracted muscle, the procedure aims to restore normal passage or function while preserving surrounding tissues. It is used in several medical specialties.

Common indications include hypertrophic pyloric stenosis in infants, treated by pyloromyotomy to relieve gastric outlet obstruction; and achalasia, treated by esophagomyotomy (Heller myotomy) to decrease the tone of the lower esophageal sphincter. Myotomies are also performed for selected strabismus cases to weaken overactive extraocular muscles.

Techniques vary by target muscle. Pyloromyotomy typically involves a longitudinal incision through the pyloric muscle layer, preserving the mucosa. Esophagomyotomy cuts the muscular layers of the distal esophagus and can be done openly, laparoscopically, or thoracoscopically; often combined with fundoplication to prevent reflux. In ophthalmology, myotomies of extraocular muscles may accompany recessions or resections to adjust alignment.

Outcomes depend on indication and technique. Benefits often include relief of obstruction or abnormal movement, but risks include infection, bleeding, mucosal injury, reflux after esophagomyotomy, and persistent or recurrent symptoms. Strabismus myotomies may cause temporary or lasting diplopia or misalignment.

Historically, pyloromyotomy and esophagomyotomy were important early 20th‑century procedures, with Ramstedt’s pyloromyotomy and Heller’s operation serving as foundational references.