With esophageal hiatal hernia, there are no medications available to correct the hiatal hernia because the anatomical findings have been altered. Internal drug therapy aims to control symptoms, cure esophagitis, and correct gastrointestinal dynamics. Sliding esophageal hiatal hernia is usually treated conservatively with internal medicine, while surgery is an option for severe cases. In the past, considering the risk of serious complications such as choking and strangulation that paraoesophageal hernias are prone to, it was clinically recommended that all paraoesophageal hernias should be detected early and treated surgically at an early stage. In contrast, recent clinical studies have concluded that paraoesophageal hernias that do not yet affect the patient’s quality of life and are associated with only mild belching and acid reflux should be closely monitored rather than overly treated surgically. Surgical treatment should be considered in patients who have failed medical treatment, combined with severe complications, whistle-circulatory failure caused by huge hernias and cannot exclude malignant changes. 1.Medication Proton pump inhibitor is the most effective drug to inhibit gastric acid secretion and treat reflux esophagitis and control gastroesophageal reflux symptoms, which can reduce heartburn, retrosternal pain and other symptoms, but has no effect on increasing the pressure of lower esophageal sphincter and improving esophageal peristaltic function. Therefore, in severe cases of esophageal hiatus hernia, a combination of gastrointestinal motility drugs should be used to improve esophageal motility and promote gastric emptying to reduce the stimulation of esophageal reflux by gastric contents. For patients with uncomplicated GERD, the guidelines do not recommend the use of single drugs for long-term treatment due to the potential side effects of pro-gastrointestinal drugs on the heart and nervous system. 2.Traditional surgery Indications for surgery: obvious symptoms and ineffective long-term treatment by internal medicine; complications such as severe esophagitis and recurrent bleeding; large hernia sac with repeated long-term impaction and cardiopulmonary compression symptoms; acute impaction or strangulation. The purpose of surgery: to repair the enlarged esophageal fissure, to treat the hernia sac, to restore the relationship between the esophagogastric angle, to strengthen the tone of the lower esophageal sphincter and to prevent reflux. Surgical methods: mainly include repair of enlarged esophageal fissure, esophageal cardia fixation, gastric fixation with fundoplication, and esophageal cardia angle restoration. 3.Minimally invasive surgical treatment Robotic replication of esophageal hiatal hernia repair is better than open surgery, and has comparable effect with traditional laparoscopic surgery, and has better safety and effectiveness. For the repair of giant hiatal hernia, robotic surgery is less traumatic and faster recovery than laparoscopic surgery, and can improve the postoperative life treatment of patients, making it a new choice of minimally invasive surgery for patients with giant hiatal hernia. 4. Application of hernia patch Postoperative recurrence of hiatal hernia in esophagus is related to the repair method. For patients with large tension or cleft defect diameter >5cm, tension-free hernia repair is currently advocated. 5.Living habits The improvement of living habits, such as reducing weight, eating less and more often, avoiding specific foods, sleeping with head high and feet low, etc., are conducive to the relief of symptoms.