Giant esophageal hiatal hernia in adults is an acquired condition that is usually seen in older women. The cause is related to the relaxation of the esophageal pathway between the thoracic and abdominal cavities. The esophagus passes through the esophageal hiatus into the abdominal cavity and is connected to the stomach. In elderly people, the diaphragmatic fissure may show varying degrees of relaxation and atrophy. If the patient’s abdominal pressure rises, over time, the stomach may enter the thoracic cavity through the relaxed and enlarged esophageal fissure, forming a “hernia”. In early or mild cases, when the abdominal pressure is reduced, the upwardly displaced stomach will fall back into the abdominal cavity, and this type of hiatal hernia is called a sliding esophageal hernia. However, when the stomach repeatedly moves up into the thoracic cavity, the “hernia sac” outside the stomach becomes attached to the thoracic cavity and gradually fails to return to the abdominal cavity. Moreover, the stomach inside the thoracic cavity becomes more and more, and if more than one half of the stomach enters the thoracic cavity we call it a giant hiatal hernia. The hiatal hernia can cause many bad sensations such as difficulty in swallowing, reflux, heartburn, chest tightness and chest pain. Giant hiatal hernia must be treated surgically, otherwise the complications associated with it will increase significantly as the patient gets older. Surgical approaches to treat giant esophageal hiatal hernia have evolved, transthoracic, transabdominal, minimally invasive, open surgery, to name a few. The leading international technique is laparoscopic hiatal hernia repair, which has the advantage of being less invasive, painless, and with rapid postoperative recovery. However, the requirements for laparoscopic technique and mediastinal anatomy are high.