Figure 5. This patient had a large (5-cm) hiatal hernia with extensive periesophageal scarring at the time of laparoscopic Nissen fundoplication. After a bout of sneezing 6 months after surgery, dysphagia developed. A barium swallow revealed a recurrent hiatal hernia, with the gastroesophageal junction (small arrow) located well above the diaphragm, and the fundoplication defect can be seen around the proximal stomach (heavy arrow) at the level of the diaphragm.