Hiatal hernia (HH) is a gastrointestinal disease related to gastroesophageal reflux disease, with various surgical repair methods, including endoscopic treatment and surgical treatment. Among them, laparoscopic HH repair has become the standard surgical method due to its minimal invasiveness and rapid recovery. The application of biological mesh in the repair of HH has shown advantages in reducing the short-term postoperative recurrence rate versus simple HH repair. Compared with synthetic mesh, biological mesh has performed better in reducing the incidence of mesh erosion and dysphagia. Future research will focus on the long-term effectiveness evaluation of biological mesh, optimization of mesh shape and materials, etc., to further improve the postoperative efficacy and quality of life of patients with HH. This article reviews and summarizes the hot issues in the application of biological mesh in the repair of HH.