Objective. Improving the results of surgical treatment of patients with complicated hiatal hernia (HH). Material and methods. A retrospective study of video endosurgical interventions for complicated HH in 163 patients was performed. Axial hernias were observed in 125 patients, 38 patients had paraesophageal hernias. According to the Granderath formula, depending on the surface area of the esophageal opening (EO), large hernias were mainly revealed: 56.8% — among the axial and 65.8% — among the paraesophageal. The most often complicated forms of HH were found in individuals of the mesomorphic body type — 85 (52.1%). Results. An algorithm has been developed for choosing the method of EO plasty depending on the size of the hernia and physique type. For small hernias, plastic was used with local tissues. The indications for the installation of mesh implants in 24 (14.7%) patients were giant HHs. Mesh implants were installed for large hernias in another 15 (9.2%) patients with a brachymorphic type of physique of the II period of mature and old age, who had atrophic changes in the muscular skeleton of the diaphragm. EO plasty was performed according to the original method, a mesh implant was installed in the posterior mediastinum above the diaphragm. Complications associated with the use of mesh implants were not observed. One year after surgery, 157 (96.3%) patients were examined. The phenomenon of «cuff slipping» arose in 3 (1.8%) of them. In the long-term period, recurrences of HH were not noted both with plastic surgery by local tissues and using mesh implants. Conclusion. The choice of the EO plasty method should depend on the size of the HH, and also be based on anatomical changes in the EO region with age and with various types of physique. It is advisable for patients with a brachymorphic type of physique of the II period of mature and old age with large HH and patients with giant hernias for all types of physique to perform EO plastic surgery using a mesh implant.