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Laparotomy can be considered as an access route among options that any oesophagus surgeon has to include in his technical experience. It can therefore either be chosen when the right indication emerges or be suggested as first line-procedure by the surgeon when he is sure that it can guarantee the best possible outcomes. Outcome that, in the Author’s experience, show the surgical procedure Heller’s extramucolas myotomy with anterior hemifundoplication according to Dor a well documented procedure the safety and effectiveness of wich has been upgraded over time through new technical devices. Their effectiveness being equal, both techniques are widely acceptable and opting for one approach or the other depends on the expertise of the single surgeon who has to consider all the possible advantages for his patients.