Most cases of hiatal hernia do not cause any observable or noticeable symptoms, and these do not require treatment. If you do require treatment, non-surgical options include medication for heartburn, to reduce or block acid production or to heal the oesophagus.
Conversely, if you are suffering from a paraesophageal hernia (when a portion of your stomach pushes thought the hiatus), this may cause a strangulation of your stomach, which can cut off the blood supply, in which case a surgery may be recommended. A hiatal surgery is performed to reduce the size of your hernia, put your stomach contents back to their original position or reconstructing the oesophageal sphincter.
An open surgery involves one large incision in your chest wall or abdomen, through which your surgeon can access and mend your hernia.
On the other hand, a laparoscopic hiatal hernia repair is considered a minimally invasive procedure. It involves small incisions in the abdomen though which your surgeon can insert a laparoscope (small tube with a light and a camera) and other instruments to repair your hernia.
Both types of surgery have advantages and disadvantages. Your doctor can help you choosing better treatment option for you depending on your condition.