Epiphrenic diverticula of the esophagus are usually associated with a concomitant esophageal motility disorder, with achalasia being the most common. Symptoms experienced by most patients are dysphagia and regurgitation, and they are considered secondary to the underlying motility disorder. While for many decades the traditional approach was through a left thoracotomy, during the last two decades a minimally invasive transabdominal approach has become the standard of care with diverticulectomy, esophageal myotomy and partial fundoplication. Recently, based on the realization that the underlying motility disorder rather than the diverticulum per is the cause of the symptoms, a myotomy alone without the diverticulectomy has been adopted often; this approach has been accomplished either laparoscopically with Heller myotomy and partial fundoplication, or by peroral endoscopic myotomy.