Currently, the best surgical treatment for cardia achalasia is laparoscopic Heller’s procedure with anti-reflux surgery. With the increasing understanding of the etiology, pathology and pathogenesis of cardia achalasia, especially the application of high-resolution esophageal manometry in clinical practice, it will be better used for the selection of surgical indications and the judgment of surgical efficacy. The surgical treatment of cardia has undergone a long development process, initially by Heller in 1913 first through the esophageal cardia extramucosal myotomy (i.e. Heller procedure) to treat cardia, after which Heller procedure has become the classic surgical procedure for the treatment of cardia due to its efficacy. The efficiency of the Heller procedure for cardia failure is 80% to 90%. With the development of minimally invasive technology, surgeons now basically choose to perform surgery under thoracoscopy or laparoscopy. The thoracoscopic or laparoscopic Heller procedure is less traumatic, has a faster recovery, is easier to perform, has a lower postoperative morbidity and mortality rate, and has better recent outcomes than the traditional Heller procedure. Since the surgical treatment of cardia failure is mainly performed by thoracic surgeons, some physicians are accustomed to thoracoscopic completion. However, compared with thoracoscopic Heller, laparoscopic Heller has the advantages of less anesthesia and more patient selectivity because it does not require double intubation, and it is easier to perform fundoplication laparoscopically. In a meta-analysis of 3086 patients, Campos et al. concluded that laparoscopic Heller should be the standard procedure for the surgical treatment of cardia failure, with a symptom relief rate of nearly 90% and a morbidity and mortality rate of 0.1%.