The development of minimally invasive techniques have revolutionized the surgical therapy of achalasia and made myotomy with or without partial fundoplication the treatment of choice for most patients. Complications do occur, however, and every effort must be made to minimize their occurrence and identify and treat them effectively when they occur to maximize the likelihood of an excellent outcome in these patients who have a benign but incurable disorder. Further studies on the best location for the myotomy as well as the best type of fundoplication will help refine the procedure for future generations of patients.