Spinal abnormalities and hiatal hernias are becoming more common in our aging population. Increasing evidence has shown that the presence of kyphoscoliosis would increase hiatal hernia formation. Kyphoscoliosis has been shown to lead to decreased quality of life, poor pulmonary function, and restrict abdominal compliance. All of these factors have the potential to increase morbidity and mortality associated with the surgical repair of hiatal abnormalities. In the present we reported two cases of hiatal hernias repair in kyphoscoliosis patients, with a prolonged duration of malnutrition due to inability to eat, and received nasogastric tube feeding or total parenteral nutrition (TPN). Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities.