This video describes the repair of a Type IV paraesophageal hernia with intrathoracic herniation of stomach and colon. The repair involves laparoscopic reduction of the stomach and colon from the chest, hernia sac excision, crural repair, and Toupet fundoplication. There were no operative complications and the patient was discharged on the third postoperative day. At six months follow-up, she is asymptomatic.