 The patient is an 18-year-old male who has had a history of a Nissen fundoplication performed six years ago for gastric reflux.  Approximately one year ago, he was involved in a motor vehicle accident and CT scan at that time showed that he had a hiatal hernia.  Over the past year, this has caused him an increasing number of problems, including chest pain when he eats, and shortness of breath after large meals.  He is also having reflux symptoms again.  He presents to us for repair of the hiatal hernia and revision of the Nissen fundoplication.