Abstract: The management of esophageal hiatal hernia depends on multiple factors, including the size and type of hernia, severity of symptoms, and efficacy of non‑surgical treatment. Currently, laparoscopic hiatal hernia repair has gradually become the primary approach for treating sympto-matic esophageal hiatal hernia due to its advantages such as minimal invasiveness, rapid recovery, and favorable outcomes. In recent years, the diagnosis and treatment model for gastroesophageal reflux disease has become increasingly standardized. However, significant controversies remain regarding the management of esophageal hiatal hernia internationally. Surgical complications, post-operative recurrence rates, and risks associated with other specialized techniques continue to be major concerns for surgeons when selecting surgical treatment for patients. The authors introduce the current focal issues in the clinical management of esophageal hiatal hernia, with an emphasis on discussing the latest international research advancements, applications, and existing challenges related to these issues.