Esophagocardiomyotomy [modified Heller procedure] is a widely accepted operation for relief of dysphagia in patient with esophageal achalasia. But patients with advanced achalasia were more likely to get poorer results from a modified Heller myotomy because of the dependent pouch that creates an angulation at the junction of thick-walled dilated esophagus with the thin wailed aganglionic segment and hinders complete emptying. Thorbjarnarson[1975] proposed the method including truncal vagectomy and pyloroplasty. Vagectomy and pyloroplasty should lesson the severity of acid-peptic esophagitis, if reflux should occur postoperatively. Here we presented 4 cases esophageal achalasia treated by modified Heller operation of 3 cases and one case of Thorbjarnarson method. All postoperative results are good.[KTCS 1979;1:67-73]