Key Points

• Paraesophageal hiatal hernia is a confusing term, and it is used interchangeably and incorrectly for both type II and type III hiatal hernias.
• Massive (type III and IV) hiatal hernia is the natural progression of a sliding (type I) hiatal hernia.
• Associated, acquired short esophagus is frequent.
• Life-threatening emergency complications are rare, and the potential for these complications is not an indication for urgent repair.
• Regardless of the approach, the principles of repair are identical.