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The distal esophagus is easily accessed by laparoscopy. Most commonly, surgery here is for reflux disease and hiatal or paraesophageal hernias. Surgery is a good option for patients with reflux disease who require chronic medication or who are not completely relieved of symptoms with medication. Patients with large hiatal hernias or who have symptoms of obstruction (dysphagia, vomiting) or chest pain from their hiatal hernias have increased risk of rupture and require repair. Even extremely large hiatal and paraesophageal hernias can be repaired laparoscopically. Recently, we have started performing laparoscopic-assisted esophagectomy for patients with precancerous lesions or small cancers of the distal esophagus.