Paraesophageal hernia incidence is around 5-8%. The Authors analyze their experience of 5 patients operated on for paraesophageal hernia after preoperative manometric and pHmetric studies. Despite only in 3 patients a gastro-esophageal reflux was present, in all cases a suture of the diaphragmatic defect together with a modified Lortart-Jacob antireflux operation was performed. The results were considered satisfactory in all cases and there was no relapse after a 2 year follow-up. Following an accurate analysis of the literature the Authors conclude that in paraesophageal hernia a surgical treatment is mandatory. However, diagnostic instrumental preoperative data influence the choice of the appropriate surgical treatment for each patient.