Laparoscopic reoperations for failed hiatal hernia repairs, while technically challenging, can be accomplished if these steps are followed. Step 1: Adhesionolysis, Step 2: Hiatal dissection Step 3: Esophageal lengthening. Step 4: Taking down the old antireflux procedure. Step 5: Crural closure and Nissen fundoplication. If these principles are adhered to, a lapaproscopic approach is safe and effective.