Good Morning
"Decisions to use endoscopic therapy (botulinum toxin or balloon dilation) or surgical myotomy are complex and benefit from the multidisciplinary approach of the Digestive Health Center."

The above quote comes from OHSU's website. It's the best advice I've seen regarding achalasia treatment. I would have benefitted had I followed it before my surgery. I've had both the Heller and the POEM. I had the POEM first (It failed, in a number of months, mostly likely because it was a misjudgment on the surgeons part. The POEM is performed using an endoscopic technique. They go in with a through your mouth. It is the least invasive and for people who are a good candidate this technique seems to work well. It appears that I was not. I am rather tall and have a long esophagus. It looks like that was simply the wrong technique to use for me. My Heller 'technically' was successful, but it has had some unintended consequences. I can swallow but not without severe pain. It even hurts to talk most of the time

And this is clearly where may case gets more complex and I would have benefitted from the approach implied in OHSU's quote. I can't entirely blame myself for this, I had never even heard of achalasia until I was diagnosed in Vermont. Their doctors referred me to Mass General (they are the most experienced in treated the disease in New England) and I had one appointment with them and Covid and the medical shutdowns set in. Shortly after I had to return to Oregon, but before having a bout of Covid myself (I don't know how that has effected the over all picture and it was well before the vaccines were available. I have since been vaccinated). I also have apparently have had the illness for close to a decade; suffering through many misdiagnosis like a lot of people with achalasia have

I know much of this recent medical background wasn't considered (along with the fact that achalasia was my fourth autoimmune disease and other important aspects of my health history) because the clinic in Portland never took a thorough health history.

Truthfully, I don't know how much of that would matter now. I had this done during the worst times of the pandemic and didn't know enough about the illness or what options were available. But it does seem obvious to me, since you're asking about surgery (and since this is a rare disease) to advise you to try and pick a surgeon who has experience with the procedure and the treatment of achalasia overall. That can be hard to find. It seems worthwhile because this can minimize the chances of suffering unintended consequences after surgery.

Philip