Myotomy is defined as a surgery in which a muscle is cut (myo- is the prefix that denotes muscle). While many surgeries may involve the cutting of some muscles, the term myotomy is reserved for a procedure with the specific intent of cutting a muscle. For example, a laparotomy requires that the abdominal muscles be cut, and, while this is myotomy strictly speaking, the procedure would not be referred to as a myotomy. On the other hand, the muscles of the esophagus or the eye are common targets for myotomy surgery.
One of the most commonly performed myotomy procedures is the Heller myotomy. A Heller myotomy is a surgical procedure that treats achalasia, which is a swallowing disorder in which the muscles of the lower esophagus do not relax during swallowing. This means that when someone swallows, the muscles of the esophagus do not squeeze in coordinated fashion to move food to the stomach as they normally would. Patients with achalasia get swallowed food stuck in the lower part of the esophagus. Severe cases of achalasia can lead to malnutrition and choking.
In a Heller myotomy, the muscles of the lower esophagus and the lower esophageal sphincter are cut. This opens the final part of the esophagus so that swallowed food can enter the stomach. Unfortunately a Heller myotomy can lead to gastroesophageal reflux disease since the lower esophageal sphincter is the primary muscle that keeps stomach acid from regurgitating up the esophagus. In order to prevent this, a Nissen fundoplication is often performed at the same time as a Heller myotomy.
During myotomy recovery, patients usually stay in the hospital for one to two days until normal swallowing resumes. After discharge, patients can return to their usual activities in about two weeks.
Another myotomy procedure that is related to a Heller myotomy is a cricopharyngeal myotomy. Instead of cutting the lower esophageal muscles, in this myotomy surgery the upper muscles are cut. This is done to treat swallowing disorders involving back of the throat. Swallowing disorders of the upper esophagus are also a form of achalasia (though less common in the upper region of the esophagus). Unlike a Heller myotomy, a cricopharyngeal myotomy does not interfere with the mechanisms that prevent gastric acid from coming up the esophagus. Therefore acid reflux is not usually a complication of this myotomy procedure. Cricopharyngeal myotomy recovery is similar to a Heller myotomy.
Myotomy Surgery for Strabismus
Another common myotomy is in the treatment of strabismus. Strabismus is a disorder of the eyes in which the pupils do not point in the same direction during focusing. The colloquial term for strabismus is “cross eyes.” The eyes are moved by a series of six muscle attached to the back of the eye. By cutting and moving just one of those muscles a few millimeters, the eyes can be permanently aligned both at rest and during focusing of the eyes.
Myotomy recovery after strabismus treatment is relatively quick, though it does require several appointments to the ophthalmologist. At follow-up appointments, the eye surgeon will check for visual acuity (how well one can see) and other factors associated with eye health.