Paraesophageal hernias account for up to 10% of all hernias of the esophageal orifice of the diaphragm. There is a high risk of infringement in this pathology. In most patients with paraesophageal hernias, videolaparoscopic complete esophagofundoplication and cruroraphy are effective. During the examination of a 68-year-old patient (X-ray of the esophagus, stomach and duodenum, fibroesophagogastroduodenoscopy, pH-metry) a paraesophageal fixed giant combined intestinal-gastric hernia of the esophageal orifice of the diaphragm was revealed. Videolaparoscopic metered esophagofundoplication, posterior diaphragmatic surgery, chiatoplasty with a polycomposite mesh, plastic surgery of the esophageal-diaphragmatic ligament were performed. In the postoperative period, on the sixth day, an X-ray of the esophagus, stomach and duodenum was performed — no violations of evacuation from the esophagus and stomach were found. With giant and large paraesophageal hernias of the esophageal orifice of the diaphragm, there are isolated observations of surgical treatment in the literature, including posterior and anterior cruroraphy, dosed esophagofundoplication, diaphragmatic curoplasty with peritonization with a mesh implant.