Anti-reflux surgery and hiatal hernia repair have received a lot of attention. The technique has evolved from open repair in the 1950s, as described by Dr. Rudolph Nissen, to laparoscopic repair, to robotic and endoscopic procedures. However, as sequelae of such repairs, patients suffer from recurrent hernias, develop pseudoachalasia, suffer mesh or Linx/magnetic sphincter augmentation erosion, and experience recurrent reflux after BarrX or transoral incisionless fundoplication. Such challenging situations warrant a thorough workup of symptoms coupled with surgical expertise and sound decision-making with experienced judgment. 

This method collection is intended to address those complex re-do foregut cases that warrant careful workup, including endoscopic evaluation, barium esophagram, and manometry, followed by sound judgment. This collection will review fundamental technical principles that guide foregut surgery. To optimize the outcome of re-do surgeries, it is critical that one take advantage of multiple disciplines followed by a well-planned, staged repair. 

1. Defining reoperative foregut surgeries
2. Optimizing patients before reoperative surgeries: smoking, anemia, nutritional status
3. Preoperative studies: barium studies, GES, endoscopy, manometry, Endoflip, CT scan, pH studies, review of prior operative reports, and preoperative studies
4. Technical considerations in reoperative foregut surgeries: addressing pseudoachalasia, mesh/foreign bodies, short esophagus (Belsey repair), gastroparesis, esophageal stricture/scarring secondary to BarrX or TIF
5. Wrong diagnosis, wrong surgery: How do you fix it? Roux-en-Y gastric bypass and esophagectomy 
6. Postoperative outcomes of reoperative foregut surgeries