A laparoscopic Heller myotomy in a child is undertaken through a 5-trocar technique.

The gastrohepatic ligament is widely opened in a stellate fashion. The esophagus is mobilized from the right and left crura. Longitudinal muscular fibers are transected with hook cautery, and then transverse fibers are divided in a cephalad followed by a caudad direction onto the stomach, well past the Z-line.

Intraoperative esophagogastroscopy is used to assure adequate myotomy.

Anterior fundoplication covers the majority of the myotomized esophagus, completing the operation.