OBJECTIVE: There is mounting evidence documenting poor results following a myotomy without fundoplication for patients with achalasia. Failure of this approach results in high rates of pathological reflux or dysphagia. We report our experience with redo-laparoscopic procedures following failure of a “tailored” myotomy for achalasia. METHODS: Between 2000 and 2004, eight patients were identified and charts reviewed. Patients underwent full investigation with upper endoscopy, upper gastro-intestinal barium study, esophageal manometry and 24 hour pH study (if possible). Data are presented as mean ± standard deviation. RESULTS: The initial myotomy was performed laparoscopically in 7 patients and via left thoracotomy in 1. Mean patient age was 46±12 years. The presenting symptoms were dysphagia due to incomplete gastric myotomy (n=6) or new onset intractable heartburn (n=2). Two additional patients had dysphagia post myotomy but refused further intervention. The median time to symptom onset was 2 months (mean 2.7±2.8 months) with no difference between symptom type. The time interval between surgical procedures was 18.4±17 months. All procedures were completed laparoscopically and included full mobilization of short gastric vessels. Procedures performed included: laparoscopic Toupet (n=5) or floppy Nissen (n=3) fundoplication with a completion myotomy in the 6 patients with dysphagia. Intra-operative perforations occurred in 3 patients during either dissection of the esophageal mucosa off the left lobe of liver (n=2) or completion of the gastric myotomy (n=1). All were repaired laparoscopically and no post-operative complications occurred. The times to oral intake and length of stay were 2.25±1.8 days and 3.7±1.5 days respectively. At a mean follow-up of 11 months, all patients report a significant improvement in their dysphagia or heartburn. CONCLUSIONS: “Tailored” myotomies for achalasia have fallen from favor due to documented high rates of post-operative reflux. In addition, despite all initial myotomies being performed with endoscopic guidance, this report also demonstrates an unacceptable 12% incidence of persistent dysphagia. Redo laparoscopic procedures in these patients are safe and successful in improving patient symptoms.