The treatment of morbid obesity with bariatric surgery may be complicated postoperatively by the development of intractable GERD symptoms. These symptoms may be seen early post op in sleeve gastrectomy patients and distant out in patients with gastric bypass. Magnetic sphincter augmentation (MSA) remains investigational or difficult to obtain. Ligamentum Teres Cardiopexy might be an alternative to consider for patients with intractable GERD.Here we present a patient who had a laparoscopic sleeve gastrectomy five years ago who then presented with intractable GERD symptoms. Her work up included upper GI series, which showed a small hiatal hernia. She was unable to tolerate a PPI due to side-effects, and was on an H2 blocker BID, and continued to have significant reflux symptoms.The procedure started with mobilization of the ligamentum teres. We then dissected the distal esophagus and proximal sleeve gastrectomy from the hiatus which showed a moderate sized hiatal hernia. The hiatal hernia was repaired with permanent sutures reinforced with pledgets. The ligamentum teres was then sutured to itself to create a 360 degree wrap. Post operatively, we obtained an esophagram, which showed no evidence of reflux. The patient tolerated both liquids and solids at 2 weeks. No post operative complications were identified. Post-operatively, the patient had resolution of her reflux symptoms, and was off all medications at 6 months. Short term follow up of seven patients receiving Ligamentum Teres Cardiopexy indicates that this is a useful fundoplication strategy for patients suffering with GERD after bariatric surgery.