This video illustrates the repair of a large paraesophageal hernia following an Ivor Lewis esophagectomy. Due to this patient's past medical history, modifications were required to improve the patient's symptoms of dyspnea on exertion while preserving her preoperative gastroesophageal function. Awareness of the altered anatomy is crucial in protecting the gastric conduit and its associated blood supply. An effort was made to reduce the intrathoracic contents and prevent further herniation by covering the diaphragmatic defect with PTFE mesh and suturing it to the diaphragmatic crura. Fundoplication as well as complete closure of the posterior aspect of the defect were unable to be performed as there was concern for injury to the gastric conduit and right gastroepiploic artery. We believe this correction will help improve the patient's symptoms and prevent further herniation through the now partially closed defect. The patient has continued to progress postoperatively with improvement in her dyspnea on exertion and preservation of her gastroesophageal function. This operation shows the modified surgical correction of a large paraesophageal hernia after an esophagectomy.