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Introduction:Treatment failure with recurrent dysphagia after Heller myotomy occurs in fewer than 10% of patients, most of whom will seek reoperation. There exist only limited reports of reoperation with esophageal preservation in such patients. Methods and Procedures:We retrospectively reviewed the records of patients presenting for symptomatic treatment failure after Heller myotomy. From March 1998 to November 2010, 47 patients were evaluated. Seven patients had undergone more than one prior myotomy. Three patients became symptom-free after endoscopic dilation and/or Botox injection therapy, and seven patients opted not to undergo reoperation. Thirty-five of 37 patients underwent reoperation with the goal of esophageal preservation. Two patients with sigmoid megaesophagus underwent minimally invasive esophagectomy as our initial reoperation. Our approach was to proceed with a takedown of their previous fundoplication, dissection of the periesophageal fibrosis, and assessment of need for an extension of the myotomy. Results:Thirty-five patients underwent laparoscopic reoperation for either presumed incomplete myotomy or anatomic distortion due to the fundoplication. Intraoperative findings were incomplete myotomy in 28 patients and fundoplication failure in 7 patients. Intraoperative esophagogastric perforation occurred in six patients. Fundoplication was not reconstructed in 15 patients. Of the 31 patients undergoing a first-time reoperation, 24 achieved relief of symptoms without re-intervention (77%). Less than half of patients undergoing two or more reoperations had successful relief of symptoms. However, esophageal preservation was possible in 32 of the 35 patients in whom it was attempted (91%). Three patients failed a strategy of esophageal preservation and eventually required esophagectomy.Conclusions:Laparoscopic reoperation with esophageal preservation is successful in the majority of patients with recurrent dysphagia after Heller myotomy. Not surprising, there is a decrement in the rate of success with each successive reoperation.