Combined paraesophageal and sliding hiatal hernia

We have reported a case of a large paraesophageal herniation with a small sliding component. Abnormal positioning of the esophagogastric junction or the necessity for mobilizing it during repair requires the addition of an antireflux procedure to the standard reduction and repair. Elective repair of a paraesophageal herniation, even in the absence of limiting symptoms, is warranted, since complications of nonsurgical treatment may be sudden and severe.