Introduction: Heller myotomy leads to good-excellent long-term results in 90% of patients with achalasia and thereby has evolved to the "first-line" therapy. Failure of surgical treatment, however, remains an urgent problem which has been discussed controversially recently.
Materials and methods: A systematic review of the literature was performed to analyze the long-term results of failures after Heller's operation with emphasis on treatment by remedial myotomy.
Discussion: Other reinterventions and their causes after failure of surgical treatment in patients with achalasia are discussed.