What is the main reason to perform a surgical myotomy in achalasia treatment?

In the treatment of achalasia, the main objective of performing a surgical myotomy is to relax the muscle at the lower esophageal sphincter. Achalasia is characterized by the failure of the lower esophageal sphincter to relax properly, leading to difficulty in swallowing and the buildup of food in the esophagus. The myotomy procedure involves cutting the muscle fibers of the lower esophageal sphincter to relieve the pressure that hinders the passage of food into the stomach.

By facilitating this relaxation, myotomy effectively alleviates the symptoms associated with achalasia, including dysphagia, chest pain, and regurgitation. This surgical intervention addresses the underlying physiological problem rather than merely treating the symptoms or performing a dilation that may not provide long-term relief. Other approaches, like pneumatic dilation, may also be used, but myotomy is a definitive surgical procedure aimed at correcting the muscle dysfunction directly, promoting improved esophageal function and patient quality of life.