myotomie

Myotomy, also known as myotomie in French, is a surgical procedure that involves cutting muscle fibers to relieve abnormal tightness, spasm, or obstruction caused by a contracted muscle or sphincter. The goal is to reduce resistance to movement or passage of contents while preserving surrounding tissues. The term derives from Greek roots meaning “muscle” and “to cut.”

Common indications include esophageal achalasia, where cutting the lower esophageal sphincter increases the passage of food; pyloric stenosis in infants; cricopharyngeal dysfunction that interferes with swallowing; and other focal muscle hypertrophies or spastic disorders. The procedure may be performed on different muscles or sphincters depending on the condition.

Procedures may be open or minimally invasive. In esophageal myotomy, a Heller myotomy is often combined with a partial fundoplication to prevent reflux. Laparoscopic or robotic approaches are commonly used. Peroral endoscopic myotomy (POEM) is a newer endoscopic technique in which a submucosal tunnel is created and the circular muscle fibers of the distal esophagus and lower esophageal sphincter are divided from within the lumen. Pyloromyotomy, such as the Ramstedt procedure, involves splitting the pyloric muscle to widen the gastric outlet and is frequently performed in infants with hypertrophic pyloric stenosis. In cricopharyngeal myotomy, the cricopharyngeus muscle is divided to improve swallowing.

Outcomes vary by condition but most procedures relieve symptoms and improve function. Complications may include perforation, bleeding, infection, and reflux after esophageal myotomy. Postoperative care often involves dietary modification and, in some cases, antireflux therapy.

Historically, esophageal myotomy was introduced in the early 20th century, with the development of POEM in the 21st century expanding minimally invasive options.