Following SCARE Guidelines and with the patient consent we present the case of a Hispanic unemployed, female patient 59 years old, with a history of high blood pressure and overweight. Surgical history of OTB at the age of 29. She came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. At the examination, no peristalsis was found in abdominal auscultation, and in thoracic auscultation intensive peristaltic was noticed. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH (Fig. 1). Our laboratory findings leukocytosis, raised LDH and lactate. We came with the diagnosis of upper intestinal occlusion due GPHE with a chance incarcerated complication. The patient prior to surgery was stable and in good conditions for intervention, we administered IV crystalloids and antibiotics. The surgery was performed by attending surgeon Dr. Gracia-Puig with advanced training in endoscopy and minimal invasive procedures. With these results, we decided to realize the procedure laparoscopically. Under anesthesia we proceed to perform a diagnostic laparoscopy. We found HH with a hiatus of 4 x 4 cm and the hernia containing 100% stomach, omentum 100%, and transverse colon. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty (Fig. 2). The dissection took around 5 h, unfortunately we had to perform omentectomy, with the loss of some blood vessels. The fundoplication was performed with Prolene 0-0 USP, with no adverse events. After the mediastinal dissection, sac excision and fundoplication we had a 4 cm long intraabdominal esophagus with purple coloration. For this reason, we monitored LDH levels daily and in rising LDH scenarios reintervention would be performed. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain. Follow up was no possible, the patient didn't came back to additional checkups (Fig. 3).