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Background Achalasia is a rare esophageal motor disorder. Laparoscopic Heller-Dor myotomy (LHD) is among the most effective treatments. The use of nasogastric tube (NGT) following LHD is still controversial. The aim of our study was to evaluate the role of NGT in achalasia patients undergoing LHD. Methods We prospectively enrolled achalasia patients treated with LHD from January 2019 until June 2022 at our institution and randomly assigned them to two groups: one group with NGT and group without (noNGT). Perioperative outcomes were compared between the two groups. ClinicalTrials.gov Identifier: NCT05729971. Results Seventy-nine patients who underwent LHD myotomy were prospectively enrolled. Patients were divided in two groups: 38 with NGT and 41 noNGT. There were no significant differences between two groups in terms of demographic data, preoperative characteristics, length of stay, start of liquid and solid diet, intraoperative and postoperative complications. First flatus was shorter in the noNGT group (p: 0.03). Conclusion Nasogastric tube placement following LHD myotomy does not reduce nausea, vomiting and chest pain, while it increased patients discomfort and time of first flatus.