The last decade has witnessed radical changes in the treatment of esophageal achalasia due to the development of minimally invasive techniques. Because of the high success rate of the laparoscopic Heller myotomy, a radical shift in the treatment algorithm of these patients has occurred, and today this is the preferred treatment modality for achalasia. This remarkable change is due to the recognition by gastroenterologists and patients that a laparoscopic Heller myotomy outperforms pneumatic dilatation and intra-sphincteric injection of botulinum toxin injection. While there is agreement about the technique of the myotomy per se, some questions still linger about the need for a fundoplication after the myotomy. The following review describes the data present in the literature in order to identify the best procedure that can achieve relief of dysphagia while avoiding development of gastroesophageal reflux.