83 year-old male with a 10-year history of achalasia. Treated with multiple esophageal dilations and underwent two laparoscopic myotomies. Consulted the ER 3 times in the last 6 months due to aspiration pneumonia requiring in-hospital treatment, with one last visit due to respiratory symptoms, retrosternal pain after food ingestion and the need to sleep with a 45 degree inclination. Esophagogram showed esophageal changes compatible with achalasia, important proximal dilation up to a horizontal area of stenosis. Decision was made to take him to the OR for a laparoscopic esophagogastroplasty taking into account age, comorbidities, recent respiratory infection, previous interventions and patient decision not to underwent esophagectomy, as it is advocated for end-stage achalasia. Operative findings included multiple adhesions between gastric fundus, great omentum and left hemidiaphragm, severe fibrotic process at the EGJ with stenosis and non-absorbable sutures at both crus. No myotomy changes were visible. Once the gastrotomy was performed, a nasogastric tube was placed to serve as a reference point for the surgical stapler to be oriented toward the esophagogastric junction, with the cartridge side toward the esophagus and the anvil side toward the fundus, avoiding as much damage as possible to the gastric mucosa. Intraoperative endoscopy showed a keyhole shaped, wide EGJ with the staple line up to 1 cm above the z line. The postoperative period went uneventfully, POP day-1 upper GI series showed appropriate passage of contrast medium being started on liquids. On follow-up patient states being asymptomatic, with no dysphagia and no respiratory symptoms