Expert consensus provides critical insights on managing paraconduit herniation (PCH) following esophagectomy, emphasizing prevention and specific patient criteria for repair.

• Preventative strategy: Avoid opening the left pleura during esophagectomy.
• Repair indications prioritize patients under 80 years, tumor-free, or those with complex herniation or enlarging PCH, while discouraging repairs for stable hernias or tumor recurrence.
• Preferred surgical methods include laparoscopic or robotic-assisted techniques with single-stitch suture hiatoplasty and gastropexy, using biosynthetic absorbable mesh for high-risk cases but avoiding tack fixation.

This consensus may help standardize PCH management and improve surgical decision-making.