The patient is a 50 year old male who was dilated at an outside hospital for dysphagia for a schatzki's ring. The gastroenterologist recognized an intraprocedural perforation and emergently transferred the patient to our hospital. A review of the CT scan obtained confirmed a perforation with mediastinal air and fluid and a sizable hiatal hernia. An endoscopic approach with a stent was considered, however due to the presence of the hiatal hernia, mediastinal contamination and early nature of the perforation surgery was decided upon. The operative approach is detailed in the video. Standard 5 trocars were placed with the patient in a split leg position with the surgeon between the patients legs.