Background

In this video we present a rare complication of paraoesophageal hernia with gastric remnant perforation after roux en y gastric bypass. A 64 year female presented several years after index procedure with worsening abdominal pain, dysphagia and imaging concerning for perforated viscous. Laparoscopic reduction, proximal remnant resection and primary repair were performed for incarcerated type 4 PEH with herniation of pouch, remnant, and transverse colon and omentum.