This video highlights a recurrent hiatal hernia repair after gastric bypass. The patient is a 43 year old female who underwent laparoscopic gastric bypass 13 years ago. Three years ago she had a hiatal hernia with pouch migration into the chest and underwent laparoscpic hiatal hernia repair with Phasix mesh. She subsequently recurred and was symptomatic. The video shows the difficult dissection secondary to the mesh and the mediastinal dissection. Technical pearls are discussed.