This chapter highlights the complexities surrounding the management of patients who experience recurrenceRecurrence or persistent symptoms after Heller’s myotomyHeller's myotomy for achalasiaAchalasia. Common causes of failure include inadequate myotomy, fibrosis-induced stenosis, and perforationsPerforation during the procedure. Various treatment options for recurrent symptoms are explored, ranging from conservative approaches to more invasive interventions like re-myotomy, pneumatic dilatation, and oesophagectomyOesophagectomy. Additionally, the chapter discusses the utility of cardioplastyCardioplasty as a technique for addressing failed myotomiesFailed myotomy, with detailed case summariesCase summaries highlighting both open and laparoscopic approachesLaparoscopic approaches. In cases of end-stage achalasiaEnd-stage achalasia where other interventions fail, oesophagectomyOesophagectomy with gastric conduit reconstructionGastric conduit reconstruction may be considered, albeit with significant surgical challenges and risks. The importance of multidisciplinary discussion and tailored treatment strategies for individual patients is underscored throughout the chapter.