Symptomatic paraesophageal hernias should be repaired. Occasionally, esophageal foreshortening is encountered. We review the case of a 73 year old female with a large paraesophageal hernia and the surgical technique of the repair. The patient had an 18 month history of shortness of breath and epigastric/chest discomfort and imaging of a large paraesophageal hernia. She underwent a laparoscopic repair. In order to obtain more intra-abdominal esophageal length, a neoesophagus was created by resection of a portion of the fundus. Trans-abdominal Collis gastroplasty is a preferred technique to obtain more esophageal length if needed during a laparoscopic paraesophageal hernia repair.