Hiatal hernias are an entity that was first clinically defined in the 20th century and went from an obscure, overlooked disease to a well known clinical entity with several diagnostic and treatment modalities, which are developing to this day. Hiatal hernias are defined as a condition in which elements of the abdominal cavity, most commonly the stomach, herniate through the esophageal hiatus into the mediastinum. They are closely associated to gastroesophageal reflux disease. Due to the specific nature of classification of hiatal hernias and their diverse presentation, it has lead to different treatment modalities, which vary from pharmaceutical, through the use of proton pump inhibitors and H2 blockers, to surgical, through the use of numerous techniques. Whilst the pharmaceutical options remained relatively unaltered since their inception, the surgical treatments developed from an open transthoracic, transabdominal approach to laparoscopic approaches and beyond. This graduate thesis intends to present the various modern surgical treatment modalities, which were built upon the experiences of pioneers in the field of antireflux surgery throughout the last 80 years. The main focus of this paper is the presentation of the newest surgical techniques, which aim to improve the outcomes of surgical procedures related to hiatal hernias and gastroesophageal reflux.