Introduction: In recent years, laparoscopic Heller-Dor operation (LapHD) has emerged as the treatment of choice for patients with esophageal achalasia. However, elderly patients are generally switched to less invasive treatments (pneumatic dilations or botulinum toxin injections). Aims & Methods: The aim of this study was to evaluate the surgical outcome in patients older than 65 years who underwent LapHD as primary treatment for esophageal achalasia. From 1992 to October 2005, we operated 29 patients older than 65 years [18 male / 11 female, median age 69 years (range 65-80), Group A]. In the same period, 207 patients younger than 65 years underwent the operation [Group B]. Fifty-one additional patients who underwent surgery after failed endoscopic treatment were excluded from the analysis. All patients underwent a detailed symptom-score questionnaire, barium swallow, endoscopy and esophageal manometry. Surgery was performed by 4 staff surgeons. Results: The median symptoms score and median duration of symptoms was similar in the two groups. Also similar were the functional and radiological findings. A similar frequency of intraoperative complication (i.e. mucosal lesions) was observed in the two groups (1/29 and 6/207), whereas the median operative time was longer in the Group A [172 min (118-280)] compared to group B [150 min (70-280), p<0.05]. Mortality was nil and morbidity was similar in both groups. The median follow-up was 30 months (1-133) in Group A and 49 months (1-131) in Group B; p=n.s. The symptoms score significantly decreased in both groups [from 21 (0-33) to 0 (0-14), p<0.05, and from 20 (0-33) to 3 (0-26), p<0.05, in group A and B respectively] even if post-operative symptoms score was lower in Group A patients than in Group B (p<0.05), together with a lower post-operative LES resting pressure [6 mmHg (2-16) vs 10 mmHg (4-50); (p<0.05)]. However, the percentage of patients classified as failure and requiring further treatment was similar in both groups (2/29 vs 22/207, p=n.s.). The same applied for patients showing post-operative GERD at pH-monitoring (1/11 in the Group A vs 6/113 in the Group B, p=n.s.). Conclusions: Ageing does not affect the feasibility and final outcome of LapHD. Surgical myotomy is a safe and effective procedure that significantly improves symptoms in all patients, irrespective of age. Older patients seems also to take advantage from the operation better than younger patients. Therefore age should no longer represent contraindication for surgical therapy of achalasia.