Paraesophageal hernia is also called type II esophageal hiatal hernia. The main herniated content is the fundus of the stomach, which can also be accompanied by the upward migration of the cardia, so the combination of short esophagus is often suspected before surgery. The main clinical symptoms of these patients are: 1) symptoms of gastric extrusion and torsion, such as difficulty in eating; 2) chest tightness and breathlessness due to thoracic occupying effect; 3) heartburn, chest pain and even vomiting blood due to gastroesophageal acid reflux. This type, together with type III hernia, belongs to the category of giant hiatal hernia, and the contents of the hernia cannot be returned to the abdominal cavity by themselves and can only be treated by surgery. Unless the clinical symptoms are mild and the patient is not suitable for surgery due to his own reasons, such as advanced age and other serious diseases, active surgical treatment can be considered to improve life treatment and prevent fatal complications. In the past, the repair of this type of hernia was mainly done through open chest or open abdomen, and the main surgical steps were: 1) return of the hernia contents and removal of the hernia sac; 2) suture reduction of the enlarged esophageal fissure; 3) freeing the fundus of the stomach and fixing it with folding sutures (Nissen’s or Toupet’s operation). The operation is not complicated, but the incision is very traumatic and the complications are high. Since 1992, when the first laparoscopic paraesophageal hernia repair was performed, laparoscopic surgery has become the mainstay of treatment for this type of hernia in foreign countries with the accumulation of experience. Although the esophageal hiatus in this type of hernia is large, most of the hiatus can be restored to normal size and tension by suturing. The patch method is still controversial in academic circles because of its inherent defects that may lead to additional complications. The diagnosis of short esophagus must be based on the gold standard seen during surgery, and the author’s experience agrees with the literature that the incidence of true short esophagus is extremely low, accounting for only 6% of patients treated initially, and therefore the cardia can often be safely pulled back into the abdominal cavity without the need for additional complex gastroplasty. The advantages of modern laparoscopic techniques over traditional open-chest and open-abdomen surgery are obvious, with significant reduction in postoperative pain, no need for gastric and abdominal drainage tubes, and rapid recovery of gastrointestinal function, often with a liquid diet the following afternoon. The average hospital stay after surgery is 3 days. The overall efficiency reported abroad is 70-94%, which is related to the experience of the operator. Postoperative recurrence is manifested in two ways, namely, recurrence of hernia and recurrence of reflux symptoms. The former can be treated by reoperation and the latter by symptomatic treatment with proton pump inhibitors.