Mucosal perforation is a common complication of Laparoscopic Heller Myotomy (LHM) for achalasia. Perforations discovered intra-operatively are usually treated with laparoscopic suturing. Perforations not identified at the time of operation generally present with sepsis and a leak. Accidental perforation during LHD is impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon's subsequent performance.