Repair of hiatal hernias is increasingly being performed through a laparoscopic approach. Indications for repair should take into account the patient’s symptoms, age, and overall health condition. Patients with an asymptomatic hernia and significant comorbidities may initially be managed with “watchful waiting.” Key steps of the laparoscopic hiatal hernia repair procedure include reducing the hernia contents, mobilization of the hernia sac, mobilization of the esophagus, closure of the cura, and performing an anti-reflux procedure (e.g., Nissen fundoplication). Intraoperative challenges include a short esophagus, for which a Collis gastroplasty should be performed. Immediate post-operative management consists of a clear diet and aggressive antiemetics. Contrast imaging is not routinely obtained. The majority of patients experience symptomatic relief after the operation, even when radiologic recurrences are present.