Epiphrenic esophageal diverticulum Since epiphrenic midesophageal diverticula are rare (1/500 000) there are no randomized studies comparing an open with a minimal invasive approach. When authors argue for one or the other approach, both sides can come up with studies with leakage rate of 20% or more and with high morbidity and mortality rates. In those results lies a mixture of surgical procedures, with different views of what to perform and when, making them hard to compare regarding outcomes. We have shown in a prospective series of 15 patients that a standardized surgical treatment of symptomatic epiphrenic diverticula through a left thoracotomy and addressing the underlying motility disorder, can be performed with no perioperative mortality and with a low complication rate. We also showed that adding an antireflux repair to the procedure the number of patients with pathological acid reflux on 24h pH-metry was 1/10. In comparison 3/5 without an antireflux repair had a pathological 24h pH-metry.