Full-thickness myotomy (FTM) offers clinical outcomes similar to circular muscle myotomy (CMM) for achalasia, but carries additional safety risks.

• Clinical success rates: 91.2% for FTM vs. 85.7% for CMM; noninferiority demonstrated.
• Higher insufflation-related events with FTM at 32.35% vs. 11.43% for CMM (p = .035).

Surgical teams should weigh the similar efficacy against the increased complication rates when considering FTM.

• Trends showed increased intraoperative bleeding and post-procedural reflux in the FTM group.