The authors report on 12 cases of para-oesophageal hernia surgically managed over the period from 1973 to 2001. They describe the etiopathogenetic factors responsible for the disease and the normal evolution of the clinical picture with the main complications, which are often the first manifestations. The main problems of surgical treatment are discussed with particular regard to the operative approach and to the usefulness of combining an antireflux procedure with the hiatoplasty.