Background: Hiatal hernia is a condition in which parts of the abdominal contents, mainly the GEJ and the stomach, are proximally displaced above the diaphragm through the esophageal hiatus into the mediastinum. Esophageal hiatus is an elliptically shaped opening most commonly formed by elements of the right diaphragmatic crus that encircles the distal portion of the esophagus in a sling-like fashion. The esophageal hiatus describes the space enclosed by the right and left diaphragmatic crura. In this anatomic position, the crural arches are mostly composed of thickened diaphragm muscle overlain with peritoneum and fibroconnective tissue. As the crura weave posteriorly behind the esophagus, they cross immediately anterior to the aorta to form the median arcuate ligament. Moving further posterior, the right crus anchors into the fibers of the anterior longitudinal ligament of the upper three lumbar vertebrae, while the left anchors into this ligament overlying the upper two lumbar vertebrae. Anteriorly, the arch and shoulders of the crura insert into the central tendon of the diaphragm. GERD is common with sliding hiatal hernia. The aim is to reduce the symptoms of GERD by decreasing gastric acid secretion. Lifestyle modifications are the first line of management and include the following: weight loss, elevating the head of the bed during sleep, avoidance of meals 2-3 hours before bedtime, elimination of “trigger” foods such as chocolate, alcohol, caffeine, spicy foods, citrus, and carbonated drinks. According to the American College of Gastroenterology, an 8-week course of PPI is the therapy of choice for symptom relief in (GERD), with no major differences in the efficacy between the different types of (PPIs). Twice-daily PPI therapy can be recommended for patients with an inadequate symptom response to once-daily PPI. Laparoscopic Nissen fundoplication may have advantages over the traditional open approach, including improved cosmesis, reduced morbidity, shorter hospital stay, decreased respiratory complications, and faster recovery