Twenty-five patients with primary achalasia were included in a study to determine and to compare the outcomes of initial treatment by dilatation or esophagomyotomy and compare long-term cost-benefits between both modes of therapy. Fourteen patients were initially treated with pneumatic dilatation (gr.1) and 11 patients underwent modified Heller's esophagomyotomy, (Grp II). Demographic data, clinical features, duration of symptoms and mean follow-up times did not differ significantly between both groups (p=NS). The average pretreatment esophageal diameter on radiograms was 4.2 ems. for group I and 4.7 ems. for group II and which did not correlate well with the clinical outcome of therapy. Clinically, remission was however significantly longer in group II (Grp.I=12 months, Grp.II=36 months at p less than 0.05). There was no significant difference between both groups as to onset of recurrent regurgitation/ retrostemal pain. The medical cost of esophagomyotomy was five time more than that of dilation (p=0.05). Even the cumulative cost of repeated dilatations (n=21) was two times lower than that of esophagomyotomy.