Paraesophageal hernia (PEH) is herniation of fundus of the stomach or very rarely other abdominal structures like colon/spleen through a hiatal opening in the diaphragm, usually towards the left side. PEH comprises about 3.5–5% of all hiatal hernias. They are more common in elderly population. Laparoscopic management of PEH is the preferred treatment of choice especially in elderly patients. The concomitant occurrence of parahiatal hernia (PH) with PEH is a very rare scenario with only a handful number of cases reported in the literature. A 72-year lady patient presented to us with chief complaints of pain abdomen in the right upper quadrant region and vomiting intermittently for the last 6 months. Upper GI endoscopy showed the presence of hiatal hernia with GE junction at 37 cm. The patient underwent laparoscopic repair of hiatus and paraesophageal hernia. The pre-operative diagnosis of PH is difficult, a laparoscopic approach is helpful both as a diagnostic as well as therapeutic tool for treatment of PH. The various things to keep in mind while dealing with such rare cases are the patient’s profile, symptoms, expected complications and outcomes.