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This video shows two procedures performed on the same patient: a per-oral esophageal myotomy (POEM) and subsequent salvage laparoscopic Heller myotomy after recurrence of dysphagia. The POEM portion illustrates the key steps of this novel procedure and shows intra-operative bleeding that may have led to the patient’s eventual clinical failure. The patient underwent a laparoscopic Heller myotomy four months later which is shown in the second part. We see that the prior POEM had not created significant mediastinal or submucosal adhesions. This is the first evidence that patients who fail POEM can then undergo laparoscopic Heller myotomy without significant added operative difficulty.