Both redo Heller myotomy and peroral endoscopic myotomy (POEM) effectively improve symptoms in patients with recurrent dysphagia after failed laparoscopic Heller myotomy, but POEM shows significant advantages.

• Both procedures achieve comparable Eckardt score reductions (redo LHM: 6.64 to 1.22 points vs. POEM: 6.71 to 1.82 points; p=0.57) and similar overall symptom improvement (76% for redo LHM and 82% for POEM; p=0.96).
• POEM is associated with shorter procedural times (89 vs. 180 min; p<0.001) and lower complication rates (9% vs. 19% intraoperatively; p=0.01; major morbidity: 4% vs. 11%; p=0.003).

Surgeons may consider POEM as a safer and more efficient option for these patients while still achieving similar symptom relief.