53-year-old female with history of laparoscopic RYGB in 2002 presented to our facility in 2017 with complaints of severe reflux symptoms and associated voice changes. She underwent an EGD that demonstrated esophageal dilation and a recurrent hiatal hernia. Manometry was performed that demonstrated normal esophageal contractility. She re-presented in 2018 with the same complaints with BMI of 41.6. Upper GI again demonstrated a hiatal hernia. The recommendation was made for repair of her recurrent hiatal hernia repair and Toupe fundoplication using her remnant to address her reflux, as well as plication of her gastrojejunostomy to address her frequent hunger and weight regain. The abdomen was entered laparoscopic and the robotic trocars were placed. The da Vinci® Xi was docked. Scar tissue and peritonium were taken down to identify the right crus. The pouch and remnant were completely freed from the left crus. The short gastric vessel were then divided to mobilize the fundus. The hiatal hernia was identified. A 40F tube was placed into the esophagus, through the gastrojejunostomy, and into the small bowel. The hiatal hernia was repaired posterior to the esophagus using two figure-of-eight sutures of 0 Ethibond. Because the crus appeared thin, a piece of absorbable mesh was placed posterior to the esophagus to cover the hiatus and tacked to the left crus. The stomach was then passed posteriorly and sutured to the right and left crus to anchor it in place. A full Nissen was not performed due to concerns for stricturing the gastroesophageal junction.