Laparoscopic Heller myotomy and Dor fundoplication – a contemporary solution for achalasia

Background: Achalasia is a rare esophageal motility disorder characterized by absent peristalsis and impaired lower esophageal sphincter (LES) relaxation. Several therapeutic options exist, but laparoscopic Heller myotomy (LHM) combined with partial fundoplication remains the gold standard.Case Presentation: We report a 52-year-old male with progressive dysphagia, regurgitation, and reflux, with a prior history of emergency Billroth I gastrectomy for a perforated pyloric ulcer. The patient had been followed in the gastroenterology clinic and underwent several endoscopic balloon dilatations. Initially effective, dilatations became increasingly short-lived, and during the last session, no relief was achieved, with impossible passage with the endoscope. At presentation, he reported extreme esophageal dilatation, frequent regurgitation of stagnant food, and nocturnal choking episodes. Laparoscopic Heller myotomy with Dor fundoplication was performed. The postoperative course was uneventful, with complete resolution of symptoms and no reflux.Discussion: Balloon dilatation yields good short-term results but is associated with a risk of recurrence and complications. Failure is usually defined by persistent dysphagia, rapid relapse, repeated procedures, or complications. In such cases, LHM offers durable symptom relief with low morbidity and mortality. Myotomy alone increases the risk of reflux, which is significantly reduced when combined with partial fundoplication.Conclusion: Laparoscopic Heller myotomy with Dor fundoplication remains a safe and effective treatment, even in patients with prior upper gastrointestinal surgery.