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INTRODUCTION: Laparoscopic Heller myotomy with partial gastric fundoplication has become the standard treatment for achalasia. While this procedure has demonstrated excellent short term outcomes, there is a paucity of data regarding long term patient symptoms and satisfaction after the operation. We report a single institution series of minimally invasive Heller myotomy with long term evaluation of gastroesophageal reflux (GERD) symptoms, dysphagia, and patient satisfaction.METHODS: A retrospective review of a prospectively-collected database was conducted for patients undergoing laparoscopic Heller myotomy from 1995-2006 under an institutional review board approved protocol. Long term follow-up evaluation was performed by mail or telephone questionnaire. Outcomes included operative data, treatment for recurrent dysphagia, GERD symptoms, and patient satisfaction with their operation. Post-myotomy reflux symptoms were assessed using the validated GERD-HRQL instrument. A score greater than 20 was considered indicative of significant reflux symptoms, as this correlated with patient dissatisfaction.RESULTS: 56 patients underwent primary laparoscopic Heller myotomy during the study period. At long term follow-up, 7 patients were deceased and follow-up was obtained in 29. Median follow up interval was 6 years (range 4-14 years). All operations were completed laparoscopically, and 18 utilized robotic assistance. All patients reported relief of dysphagia postoperatively. At long term follow up, 72% of patients had received no further treatment for dysphagia. Of those with recurrent dysphagia, 2 patients underwent Botox injection, 5 underwent pneumatic dilatation, and 1 required a second esophageal myotomy. All patients reported adequate relief of dysphagia after repeat intervention. 55% of patients use acid-reducing medications to control GERD symptoms; however, only 10% of patients reported Velanovich scores indicative of severe GERD that impacts patients’ overall satisfaction with their operation. When asked to reconsider their achalasia treatment, 97% of patients would choose laparoscopic Heller myotomy again. CONCLUSION: Laparoscopic Heller myotomy provides durable, effective, long term dysphagia relief in the vast majority of patients. At a median follow-up interval of 6 years, patients remain highly satisfied with the operation. While many patients report mild reflux symptoms, up to 10% report symptoms indicative of significant GERD that negatively impacts overall satisfaction with the operation.