Our current surgical management of esophageal achalasia consists of a transabdominal myotomy, which extends above from the dilated portion of the esophagus inferiorly, along the anterior aspect of the lesser curvature of the stomach for three to four centimeters beyond the esophagogastric junction. An anterior hemifundoplication of the Dor type is added. The operation is performed with intraoperative, manometric control in order to verify the completeness of myotomy, and to calibrate the antireflux procedure so that undue dysphagia is avoided. In the presence of an a peristaltic esophagus, the antireflux operation must be efficient for reflux control, but no so "efficient" as to result in significant dysphagia. Sixty-five patients have been operated on with this Heller-Dor procedure, with a median follow-up of 68 months.