A 61 year old woman presented with 2 year history of dysphagia, regurgitation, heartburn, chest pain and weight loss. Barium swallow showed a dilated and sigmoid shaped esophagus. Esophageal manometry showed a hypertensive and non-relaxing LES with absence of esophageal peristalsis. Cardiac evaluation was normal.

The patient underwent a laparoscopic Heller myotomy and Dor fundoplication. The esophagus was completely straightened by dissection around it in the posterior mediastinum. Total blood loss was 20 cc. The operation lasted 1hour and 20 minutes.. Postoperatively she was fed the next morning and discharged home in the afternoon. During her last follow-up visit she was asymptomatic.

We feel that esophageal dilatation by itself, even when the esophagus is sigmoid shaped, should rarely serve as an indication for esophagectomy rather than myotomy as the initial surgical treatment.