Background <p>Paraesophageal hernia (PEH) repair following sleeve gastrectomy is technically challenging due to altered anatomy, absence of the gastric fundus, and mesh-related complications at the hiatus. Autologous tissue reinforcement may provide a durable alternative.</p> Methods <p>We present a video article demonstrating laparoscopic PEH repair in a patient with prior sleeve gastrectomy, utilizing the ligamentum teres hepatis as a pedicled buttress for crural reinforcement.</p> Results <p>The hernia was successfully reduced, adequate intra-abdominal esophageal length was achieved, and posterior cruroplasty was reinforced using the ligamentum teres. The postoperative course was uneventful, with resolution of reflux symptoms and no early recurrence.</p> Conclusion <p>Ligamentum teres buttress is a safe, feasible, and mesh-free option for crural reinforcement in complex PEH repair after sleeve gastrectomy.</p>