Hiatal hernias are divided into axial hernias (Kahrilas type I) and paraesophageal hernias (type II–IV). Axial hernias without reflux do not require surgery. Symptomatic paraesophageal hernias should be operated on. The aim of hiatal hernia surgery is to improve the quality of life. Typical symptoms such as dysphagia, dyspnea, aspiration and chronic anemia should be avoided in the long term. The perioperative results are significantly influenced by the comorbidity of the patient at a very advanced age. Possible complications include dysphagia, gastric emptying disorders, bloating and flatulence. In the long-term course, the most important complications are reflux recurrence and recurrent hernia.