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Background: The controversy about the myotomy length on the gastric side for esophageal achalasia is still an unexplored field. The aim of this study was to investigate the final outcome after classic myotomy (CM) vs long myotomy on the gastric side (LM) in two cohort of achalasia patients.Patients and Methods: We evaluated 44 achalasia patients who underwent laparoscopic Heller Dor. Patients with sigmoid-shaped esophagus were excluded. Symptoms were scored using a detailed questionnaire for dysphagia, regurgitation, and chest pain; barium swallow, endoscopy and esophageal manometry were performed, before and 6 months after surgical treatment. 24 hours pH-monitoring were performed 6 months after the Heller Dor.CM was defined as gastric myotomy length between 1.5-2.5 cm and LM as 2.5-3 cm gastric myotomy length. The surgical treatment (CM or LM) were performed in two consecutive cohorts. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. > 7).Results: 44 patients (M:F=24:20) represented the study population: 20 patients underwent CM and 24 patients had LM. Demographic and clinical parameters (age, sex, symptom score, duration of symptoms, esophageal diameter and manometric pattern) were similar among the two groups. Median follow-up was 18 months (IRQ 8-33). Mucosal tears were nil in both groups. One patient per each group was considered a failure. In the CM group the median symptom score decreased from 19.5 (IQR 13.5-20.5) to 0 (IQR 0-4) (p<0.0001). The median LES resting pressure dropped from 23.5 mmHg(18-30) to 10 mmHg (7-15) (p=0.006) and the median LES residual pressure from 11 mmHg (8-17) to 1.5 mmHg (0.4-3) (p=0.002). In the LM the preoperative symptom score median was 16.5 (11-21.5) vs 3 (0-5) (p<0.0001) of the postoperative evaluation. The median LES resting pressure decreased from 28 mmHg (25.6-66.8) to 10.3 mmHg (7-18) (p<0.0002) and the median LES residual pressure from 15 mmHg (7-39.5) to 3.7 mmHg (1.3-7) (p=0.0005).Post-operative symptom score, resting and residual LES pressure, total and abdominal LES length were not statistically different in the two groups. Positive post-operative 24 hours pH-monitoring were similar in the two groups. Seven patients changed the manometric pattern after surgery (2 CM and 5 LM).Conclusion: Extending the myotomy length into the gastric side over 2.5 cm doesn’t change the final outcome of laparoscopic Heller Dor.