This video demonstrates and discusses an esophagomyotomy (Heller Procedure) performed on a 10 year old girl for achalasia. Because the operation is performed through a left thoracotomy, exposure is excellent. This video demonstrates the importance of not extending the esophagomyotomy beyond the gastroesophageal junction and not disrupting the esophageal hiatus with the intention of preventing postoperative gastroesophageal reflux.