Achalasia of the esophagus is a disease characterized by the lack of peristalsis, the lack of adequate and complete lower esophageal sphincter relaxation, and the presence of high pressure at the lower end of the esophagus. Therapy is directed to decreasing resistance to flow through the sphincter. To a certain degree both pneumatic dilatation and Heller myotomy achieve this effect in the majority of patients, facilitating esophageal emptying. Surgical treatment, however, has an advantage over dilatation: A myotomy performed under direct vision can relieve the obstruction more precisely, more often, and with fewer complications than the blind rupture of the muscle fibers obtained with dilatation.