Our patient was a 29 year old female who presented with symptoms of GERD including heartburn, chest pain, dysphagia, and regurgitation despite maximal medical management. She underwent an objective work-up which revealed a small hiatal hernia, a DeMeester score of 31.5, LA Classification grade A esophagitis, and normal esophageal motility. She was consented for a laparoscopic hiatal hernia repair and Nissen fundoplication. Intraoperatively, she not only had a small hiatal hernia but also a parahiatal diaphragmatic hernia with incarcerated omentum. She underwent a laparoscopic hiatal and parahiatal hernia repair with biosynthetic mesh. She recovered well from the operation with full symptom resolution.