This is a presentation of a laparoscopic Heller myotomy with diverticulectomy and anterior fundoplication. Dysphagia due to achalasia can be formidable. As well, a diverticulum can complicate achalasia. A diverticulum can develop as a consequence of high intra-esophageal pressures brought about by failure of the lower esophageal sphincter to relax in the face of spastic esophageal contraction. A large esophageal diverticulum can act as a reservoir for food and debris and can exacerbate symptoms of dysphagia. The treatment of achalasia for this patient was complicated by the development of a large esophageal diverticulum. The patient involved with this operation experienced progressive dysphagia, and ultimately was reduced to consuming liquids. The myotomy was undertaken laparoscopically through a 5-trocar technique with the camera placed at the subxyphoid position to optimize videoscopic exposure. The hiatus was dissected to allow for exposure of the mediastinum and, ultimately, for excision of the esophageal diverticulum utilizing a laparoscopic stapling device. The myotomy was undertaken to relieve symptoms as well as any potential esophageal emptying obstruction distal the diverticulectomy. The hiatal reconstruction was undertaken after the fundoplication was constructed so that the fundoplication could be constructed well onto the esophageal wall and would remain in the peritoneal cavity. The postoperative upper GI contrast study documented rapid emptying of the esophagus with an intact staple line at the diverticulectomy site. The patient has done well postoperatively, and now has near normal swallowing and is without complaints. Long-term results continue to promote laparoscopic Heller myotomy for symptomatic achalasia. Laparoscopic Heller myotomy with diverticulectomy, hiatal reconstruction and anterior fundoplication can relieve severe dysphagia due to achalasia without promoting gastroesophageal reflux and is a preferred therapy.