Paraesophageal hernias (PEH) represent a minority of hiatal hernias and yet have the highest potential for catastrophic consequences for patients. Patients with paraesophageal hernias tend to be older with more comorbidities. The risk to benefit calculation in the treatment of patients with a minimally symptomatic PEH can complicated. Surgical repair and management of hiatal hernias has come a long way since the first repairs were undertaken. Surgical risk has become minimal, while gains in quality of life have increased. Decisions for surgery should be undertaken by well informed patients who have benefited from consultation with a gastroenterologist and foregut surgeon. For most patients suffering with a symptomatic PEH, the risk benefit calculation has swung firmly toward surgical repair when a multi-specialty approach is taken.
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