Laparoscopic repair of large paraesophageal hiatal hernia with defects too large to close primarily or greater than 8 centimeters is technically challenging. The ideal repair remains unclear and is often debated. Utilizing the gastric fundus as an autologous patch to obliterate and tamponade large hiatal defects may offer a new solution. Here we present a case report of a large paraesophageal hernia with an associated gastric herniation through a gastric band. We present a modified Toupet repair using the gastric fundus as an autologous patch.