Esophageal diverticulum (ED) is a rare esophageal disorder, characterized by an outpouching of mucosa and submucosa through the muscular layers, within 10 cm above the cardia. It has high etiological and pathophysiological variability, but the common denominator is a motor disorder that might cause a contractile discoordination between the distal esophagus and the lower esophageal sphincter. The clinical presentation ranges from asymptomatic, and therefore incidentally detected, which accounts for the vast majority of cases, to recurrent regurgitation and inhalation that may cause pneumonia. Due to the complexity of the disease and the subsequent treatment with numerous variables, a complete diagnostic work-up is required to assess the most appropriate approach for every specific case. Traditionally, the surgical approach was performed through a left thoracotomy and the diverticulectomy was completed with esophagocardial myotomy and a Belsey Mark IV fundoplication. At the beginning of minimally invasive surgery, simple diverticulectomy was attempted through thoracoscopy but this approach was abandoned for the high incidence of leaks from the stapled suture of the diverticular neck. Laparoscopy, on the contrary, offers many advantages in the treatment such as the possibility of a good diverticulectomy, the extension of the myotomy from the lower esophagus through the sphincter and the sling fibers, and the possibility to add an antireflux procedure to prevent postoperative reflux. The abdominal approach is also more comfortable for the patients and, as there is no need for transthoracic drains, it is better tolerated in terms of postoperative pain.