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A paraesophageal hiatal hernia is a unique type of hiatal hernia that puts the stomach at risk for twisting. A hiatal hernia repair involves removing scar tissue tethering the stomach into the chest and releasing the stomach into the abdomen. A biologic mesh-like barrier or an esophageal lengthening procedure (Collis gastroplasty) are sometimes necessary if the hiatal hernia is large or if the esophagus has shortened due to chronic disease.