Abstract: Objective: To explore the operating approach and clinical efficacy of transthoracic approach for surgical treatment in children with esophageal hiatal hernia (HH).Methods: Fourteen children with HH were treated by operative repair through the left thoracical route and Belsey's antireflux surgery.Three of which were sliding hiatus hernia (typeⅠ),one of which was paraesophageal hernia (typeⅡ),and another 10 children were mixed hernia (type Ⅲ).Results: The procedures were successfully completed in all patients and had good outcome.The operation time was 130-180 min,length of hospitalisation was 15-31 days,and the extubation time was 3-11 days after operation.All patients were followed up from 3 months to 2 years,the preoperative symptoms were disappeared.The children had gained weight and height,and were healthy during the follow-up.Conclusions: The children in Type Ⅰwhose symptoms cannot be controlled by drug measures and the children in TypeⅡ,Ⅲ should do early surgical treatment.Transthoracic approach operative repair of HH and Belsey's antireflux surgery is a kind of technique with good operative field,small concealing incision,easy to operate and repair,and low dysphagia incidence.It is an effective and practical approach for the surgical treatment of HH.