The “short” oesophagus presents a significant challenge in the surgical management of large hiatus hernias, as the gastro-oesophageal junction (GOJ) cannot be brought below the diaphragm after mobilisation. Whether congenital or acquired due to chronic gastro-oesophageal reflux disease, the diagnosis of true oesophageal length can only be established at operation. Thorough dissection and mobilisation of both the oesophagus and the GOJ are essential for accurate diagnosis and effective treatment. Although techniques such as Collis gastroplasty have been described for lengthening the oesophagus and restoring the GOJ below the diaphragm, the procedure is difficult with variable outcomes and postoperative complications. This underscores the need for careful patient counselling and planning including thorough mobilisation of the oesophagus before considering a gastroplasty. While postoperative dysphagia and reflux remain concerns, meticulous surgical approaches offer the best chance for successful management of the short oesophagus in large hiatus hernias.