Gastric and esophageal leaks after paraesophageal hernia repair can result in significant morbidity and mortality. These are classically managed with surgical or radiographically-guided drainage, endoscopic stenting, and in severe cases, resection with discontinuity until the leak is controlled. An emerging therapy, endoluminal negative pressure wound therapy (E-VAC), has demonstrated significant success in the management of post-esophagectomy and post-gastric sleeve leaks. Studies describe success rates as high as 85-90% which significantly exceeds that of stenting (approximately 50-60%). We describe the use of an E-VAC for a gastric perforation into the left chest from a recurrent, partially herniated fundoplication for redo paraesophageal hernia repair. The post-operative course was complicated by pulmonary embolus on POD1 followed by severe retching with partial re-herniation of the fundoplication on POD3. Endoscopy on POD6 demonstrated a 2cm defect in the fundoplication that communicated with the left chest. This was stented and multiple thoracostomy tubes were place. Given a lack of progress, continued pleural effusion, and poor ventilatory status, there was a high suspicion for persistent leakage. Endoscopy on POD 14 showed no difference in the size of the gastric perforation thus the stent was removed and replaced with an E-VAC. The E-VAC was exchanged every 3-5 days for a total of 14 days and 3 exchanges. Repeat Computed Tomography demonstrated no evidence of leak and the patient was discharged home on POD39. In conclusion, E-VAC therapy is safe and effective for complex, post-operative leaks/perforations and should be considered as a potential first-line therapy.