The paper report the case of a patient brought to the Authors' attention suffering from megaesophageal cardial achalasia who had already undergone gastroduodenal resection according to BII. It was considered worthwhile to report this case due to the problems which arose concerning the choice of a thoracic rather than abdominal route owing to the impossibility of associating cardiomyotomy with anti-reflux plastica surgery because of the reduced dimensions of the stomach.