Introduction: This study was undertaken to determine long-term outcome after diverticulectomy, laparoscopic Heller myotomy, and anterior fundoplication for achalasia complicated by epiphrenic diverticulum. Methods: 15 of 300 patients undergoing laparoscopic Heller myotomy concomitantly underwent epiphrenic diverticulectomy and anterior fundoplication and 39 months later, using a Likert scale (0=never/severe to 10=always/very severe), they scored the frequency and severity of dysphagia, choking, chest pain, vomiting, regurgitation, and heartburn. Outcomes for 60 concurrent patients without diverticulectomy are compared. Results: Premyotomy, patients with epiphrenic diverticula had less frequent dysphagia and regurgitation, and less severe dysphagia, choking, and vomiting compared to patients with achalasia alone (p<0.05, Mann-Whitney U test). There were no conversions to celiotomy and only one late minor uncomplicated leak. Pneumonia (N=3) was the most notable complication. After diverticulectomy, frequency and severity of all symptoms improved (p<0.05, Wilcoxon matched pairs test) and were similar to symptoms after myotomy without diverticulectomy (Mann-Whitney U test). After myotomy with diverticulectomy vs. myotomy alone, 70% vs. 90% reported their symptoms were greatly improved / resolved, 70% vs. 90% felt their outcome was satisfying or better, and 70% vs. 86% felt that they would undergo laparoscopic Heller myotomy (± diverticulectomy and fundoplication), if necessary. Conclusion: Preoperatively, patients with epiphrenic diverticula had relatively less frequent and severe symptoms of achalasia, possibly because of chronicity of the underlying achalasia. Epiphrenic diverticulectomy adds little morbidity or complications to and does not alter efficacy of laparoscopic Heller myotomy and anterior fundoplication, though it carries relatively lower patient satisfaction for reasons that are unclear. Laparoscopic epiphrenic diverticulectomy, Heller myotomy, and anterior fundoplication relieve the symptoms of advanced achalasia safely and their application is encouraged.