Hiatal hernia is a rare disease in Korea compared to western countries. It is even rarer to find the one that requires operation after unsuccessful medical treatments. We operated three cases of hiatal hernia with gastroesophageal reflux by Belsey-Mark IV procedure. One case developed paraesophageal hernia postoperatively and we performed laparotomy to correct the complication. Postoperatively, all three cases showed satisfactory results clinically and radiographically.