Background

We present our video of a 43 year old woman who was evaluated for surgical weight loss in setting of failed Nissen fundoplication with recurrent type III hiatal hernia and GERD. The patient underwent robotic assisted takedown of Nissen fundoplication, type III hiatal hernia repair, and Roux-en-Y gastric bypass. The patient tolerated the procedure well and was discharged on postoperative day 1 with no further complications on follow up and improvement in reflux symptoms. Patients with hiatal hernia in setting of morbid obesity may benefit from concurrent hiatal hernia repair with Roux-en-Y gastric bypass. In rare instances, patients may require takedown of previous fundoplications in order to restore anatomy prior to gastric bypass. It is imperative to use appropriate technique to avoid injury to critical structures including the left gastric artery, esophagus, and pleural spaces during the course of this dissection. Additional investigation is warranted to identify patients who may benefit from concurrent hiatal hernia repair during gastric bypass.