INTRODUCTION: Epiphrenic diverticulum is a rare condition with a prevalence lower than 2% and large diverticula may cause symptoms in up to 20% of patients. METHODS: We present a case of a 37-year-old female with worsening dysphagia to solids and dyspnea after eating. An upper endoscopy showed a large distal esophageal diverticulum. RESULTS: After trocars placement, the liver was cranially retracted and the dissection begins on the lesser stomach curvature. After ligation of the short gastric vessels, the stomach is completely mobilized and mediastinal dissection was carried out after partial incision of the right crus. Once the epihrenic diverticulum was identified, an intraoperative EGD was performed. The neck of the diverticulum was dissected and divided with the aid of a linear stapler. The staple line was reinforced with running sutures and fibrin glue. A subsequent 12-cm Heller esophagomyotomy was performed starting 2cm into the stomach. A Dor fundoplication was then performed with interrupted gastro-seromyotomy sutures on the lesser and greater curvature sides of the myotomy. The diaphragmatic crus was posteriorly and anteriorly approximated with running barbed sutures. Lastly, a drain was placed into the posterior mediastinum near the staple line. The patient had an uneventful recovery and was discharged on postoperative day 5. CONCLUSION: Epiphrenic diverticulum is commonly associated to dysphagia, food regurgitation and chest pain. In patients with a persistent complaint or to prevent complications, such as recurring aspiration, surgical treatment is indicated.