Introduction: Epiphrenic diverticula of the esophagus are usually associated with a concomitant esophageal motility disorder. The main symptoms experienced by patients are dysphagia, regurgitation, and aspiration. The best surgical treatment is still debated, particularly the need for a myotomy in addition to resection of the diverticulum.
Discussion: While for many decades the traditional approach was through a left thoracotomy, more recently, minimally invasive techniques have been successfully used and are now the procedure of choice in most cases. The purpose of this article was to review (a) the current understanding of the pathophysiology of epiphrenic diverticulum, (b) how this understanding should guide the surgical treatment, and (c) the surgical approach.