Since the etiology of achalasia is still unknown, all available treatments are palliative and address the unrelaxing lower esophageal sphincter. Introduced in the early 1990s, laparoscopic Heller myotomy (LHM) rapidly became the procedure of choice. However, surgical disruption the lower esophageal sphincter with myotomy carries an intrinsic risk of triggering the opposite condition, that is, gastroesophageal reflux disease. Most authors therefore complete the operation by adding a partial, anterior or posterior fundoplication to minimize this complication. In this chapter, we describe the technique of LHM with or without fundoplication, and discuss the advantages and disadvantages of the different commonly used antireflux techniques.