Paraesophageal hernias account for about 5 to 10% of all hiatal hernias. The surgical approach to these hernias has radically changed over the last 15 years, as mostly patients who are symptomatic are operated on nowadays, and preferably by a laparoscopic approach rather than by laparotomy or thoracotomy. We reviewed the surgical repair of paraesophageal hernias, focusing particularly on the operative approach and technique.