We present a video of a giant epiphrenic diverticulum excised laparoscopically.

The patient is a 68 year old man with longstanding reflux symptoms, marked by recent episodes of aspiration. Esophogram showed a giant epiphrenic diverticulum. Manometry showed normal peristalsis and LES relaxation.

A laparoscopic excision of the diverticulum was performed along with an esophagomyotomy and Dor fundoplication. The case is interesting because the diverticulum arose from the anterior side of the lower esophagus, instead of the right side (which is the usual case). The diverticulum's anterior origin facilitated dissection and made removing it easier. It also facilitated the esophagomyotomy. A Dor fundoplication completed the procedure.

Large, enlarging, or symptomatic epiphrenic diverticulae should be excised and a myotomy performed whether an associated motility disorder is present or not. Even when the diverticulum is large, a laparoscopic abdominal approach is preferable thoracic approaches.