The patient is a 70 year old male with a history of achalasia diagnosed almost twenty years ago. He underwent laparoscopic Heller myotomy with Toupet fundoplication at that time. He experienced good symptom relief for approximately five years, however he subsequently suffered progressive recurrent dysphagia to both liquids and solids. Manometry demonstrated low resting pressure of the lower esophageal sphincter and 100% aperistalsis. Endoscopy and esophagogram confirmed a severely dilated esophagus with an abrupt transition to a markedly narrowed segment likely corresponding to the prior fundoplication. The appearance was not yet consistent with end-stage sigmoid esophagus. Laparoscopic revisional surgery was pursued with a complete mobilization of the esophagus and the hiatus, takedown of the prior fundoplication, and extension of inadequate gastric myotomy. The patient experienced excellent symptomatic improvement and is doing well at two week follow-up. He has been advanced to a regular diet and is awaiting six-week follow up.