Causes of failure of an operation to correct dysphagia and regurgitation in achalasia are three: 1) too short myotomy on the esophagus or stomach; 2) omission of partial fundoplication causing reflux esophagitis stricture; or, 3) full fundoplication which is obstructive. This video illustrates third time operations in two patients both treated initially by myotomy only. In Patient A, two myotomies done by laparotomy failed to extend far enough into the spastic lower esophageal muscle requiring long myotomy and partial fundoplication. In Patient B, initial myotomy without fundoplication led to peptic stricture treated at the second operation by a resection and end-to-side esophagojejunostomy.