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Hiatal hernia is a rare condition, which may be a cause of important clinical problems either as a mediastinal mass or as a cause of failure of the antireflux mechanism. Nineteen patients treated for paraesophageal hiatal hernias were included in the study. We investigated demographic data, diagnostic studies and symptoms of the patients together with the type of operation and outcome. Respiratory and gastrointestinal complaints were the prominent symptoms in most patients. Plain X-ray, contrast radiological study and esophagoscopy were used in the diagnostic workup. Surgical repair was performed via thoracic, abdominal or thoraco-abdominal approaches. Concomitant antireflux procedures were performed in 13 patients. Hiatal hernias in children may be asymptomatic or may present with a variety of symptoms or dramatic complications. Because of the risk of complications, surgical treatment is necessary shortly after diagnosis. Repair of the hiatus combined with antireflux surgery seems to yield satisfactory results.