Twenty-one patients underwent reoperation for achalasia after various unsuccessful surgical procedures designed to relieve chronic esophageal symptoms. The chief cause for their continued disability was either persistent obstructive achalasia or incompetence of the cardia with esophagitis and stricture. Continued esophageal obstruction with persistent achalasia was caused chiefly by complete or partial healing of a previous improperly performed esophagomyotomy. The performance of a new myotomy at reoperation usually effected a satisfactory result. Incompetence of the cardia followed previous operations which totally destroyed or bypassed the distal esophageal sphincter. At reoperation, the resultant lower esophageal stricture required resection for relief.