This video is a case report of an early obstruction after sleeve gastrectomy. The patient is a 58 year old female who underwent a sleeve gastrectomy with concomitant hiatal hernia repair. Initial post operative course was unremarkable and the patient was discharged on post operative day 1. She represented in 48 hours with complete oral intolerance. She had an upper gastrointestinal series performed which showed a complete obstruction at the gastroesophageal junction. She was taken to the operating room and found to have an acute recurrence of the hiatal hernia with intrathoracic sleeve migration and incarcerated omentum in the mediastinum. She continued to have oral intolerance and eventually needed a stent. The video shows the technical details of the repair. The discussion highlights complications of hiatal hernia repair and the treatment.