Laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. The best place to start the myotomy is about 2 cm above the gastroesophageal junction, where the submucosal plane is easier to find. Essential to the operation is the length of the myotomy. Some recommendations advocate for 4 to 8 cm proximal and 0.5 to 2 cm distal myotomy, which have been associated to lower dysphagia rates and LES resting pressures. Oelschlager et al. have shown that when the distal myotomy in the stomach is increased to 3 cm, both dysphagia rates and LES resting pressures are further reduced, with no associated increase in pyrosis, regurgitation, or thoracic pain.
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