Oesophageal myotomy

Oesophageal myotomy (or Heller myotomy) is a procedure that can be performed to treat a lower oesophageal sphincter (LES) that fails to relax (e.g. achalasia). The procedure involves a longitudinal incision of the distal oesophageal musculature to break the sphincter tone.

A fundoplication wrap can be performed to restore some patency to the lower oesophageal sphincter. A section of the gastric fundus is wrapped around the gastro-oesophageal sphincter to mechanically apply some tone to the junction. There are several variations, including

  • Nissen fundoplication: the gastric fundus is passed behind the distal 6 cm of the oesophagus and a 360° wrap is performed by pulling some of the fundus anteriorly as well and attaching the two ends anteriorly
  • Toupet fundoplication: Similar to a Nissen, but a 270° wrap
  • Dor fundoplication: the fundus is pulled anteriorly <180°

A more recent technique of per-oral oesophageal myotomy (POEM) is increasing in use in some centers.

Radiographic features

Fluoroscopy: barium swallow
  • there may be characteristic "ballooning" of the distal oesophagus after a myotomy (50%), as the oesophagus bulges through the myotomy 3-4
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Article Information

rID: 38462
Synonyms or Alternate Spellings:
  • Heller myotomy
  • Esophageal myotomy
  • Toupet fundoplication
  • Dor fundoplication
  • Ballooning of the oesophagus
  • Ballooning of the esophagus
  • Oesophageal myotomies
  • Heller myotomies

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Cases and Figures

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    Case 1: normal "ballooning" of the distal oesophagus
    Drag here to reorder.
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