The video describes the technical aspects of a Laparoscopic Distal Esophageal Epiphrenic Diverticulectomy, Heller Mytomy, Modified Dor Fundoplication, in association to a Roux-en-Y Gastric Bypass (RYGB). The patient is a 42 y/o female, with a BMI of 42, which came to the practice in search of bariatric surgery and had a preference for a Laparoscopic Sleeve Gastrectomy (LSG). During clinical interview was found to have mild daily symptoms of regurgitation and once or twice weekly heartburn. An upper gastrointestinal endoscopy found a distal esophageal epiphrenic diverticulum. A barium swallow confirmed the esophageal diverticulum, and also showed preserved esophageal peristalsis with some few tertiary distal contractions, good flow through GE junction and minimal contrast reflux into the esophagus. Our group recommendation was to offer a RYGB, adapted to the simultaneous surgical treatment of the distal esophageal epiphrenic using standard laparoscopic surgical technique. In addition, we propose that a LSG is contra-indicated in this patient's clinical scenario. Reason being that the Heller Myotomy, considered an essential step to treat a distal esophageal epiphrenic diverticulum, irrespective of the identification and diagnosis of any esophageal and lower esophageal sphincter (LES) disorder, will render the LES ineffective. Thus, with the myotomy, patient's risk for post-operative GERD with a LSG and possibly a leak at diverticulectomy site is significantly increased. We present the technical details and modifications needed to complete the surgical procedures, including the need for a trans-gastric circular stapler anvil insertion below the Heller myotomy and a modified Dor fundoplication using the excluded stomach.