Recently, the Department of Gastrointestinal Surgery of the People’s Hospital of Inner Mongolia Autonomous Region independently completed a case of complete laparoscopic esophageal hiatal hernia repair and fundoplication (laparoscopic Nissen fundoplication, LNF) successfully. The patient was an elderly woman of nearly 70 years old who was admitted to the hospital with recurrent belching, acid reflux and retrosternal burning pain for more than 10 years. The patient was diagnosed with esophageal hiatal hernia with reflux esophagitis after barium meal of upper gastrointestinal tract and gastroscopy. The gastrointestinal surgery department attached great importance to this case and decided to perform laparoscopic esophageal hiatal hernia repair and fundoplication (Nissen procedure) with minimal trauma and quick recovery after the whole department consultation. Five small holes of 5-10 mm were made in the upper abdomen, and laparoscopic dissection of the fundus and lower esophagus, repair of the esophageal hiatus and 360-degree fundoplication were performed through laparoscopy and minimally invasive surgical instruments. The whole operation was very smooth and anatomically clear, and the operation took only 120 minutes, with only a very small amount of bleeding during the operation, and the patient recovered well after the operation. Wang Ju of the Department of General Surgery of the People’s Hospital of Inner Mongolia Autonomous Region, a disease caused by the entry of intra-abdominal organs (mainly the stomach) into the thoracic cavity through the diaphragmatic esophageal hernia (hiatus hernia). Esophageal hiatal hernia is the most common of diaphragmatic hernias, accounting for more than 90% of cases. Esophageal hiatal hernia is generally divided into four types: sliding esophageal hiatal hernia (type I), in which the cardia is displaced upward; paraesophageal hiatal hernia (type II), in which the cardia remains in a normal position and the bottom of the stomach is herniated through the esophageal hiatal hernia into the thoracic paraesophagus; mixed esophageal hiatal hernia (type III), in which the paraesophageal hiatal hernia and cardia are displaced upward into the thoracic cavity; and giant esophageal hiatal hernia (type IV), characterized by herniation into other intra-abdominal organs in addition to the stomach. Gastroesophageal hiatus hernia has the following three symptoms: 1. Gastroesophageal reflux symptoms, such as burning sensation behind the sternum or under the saber, regurgitation of gastric contents, epigastric fullness, belching, and pain. The nature of pain is mostly burning or pins-and-needles pain, which can radiate to the back, shoulders, neck, etc. The symptoms may be triggered and aggravated by lying down, eating sweet and acidic foods. This symptom is especially common in sliding hiatal hernia.2. Complication symptoms, such as: (1) Bleeding: hiatal hernia can sometimes bleed, mainly due to esophagitis and hernia bursitis, mostly chronic small amount of oozing blood, which can lead to anemia. (2) Reflux esophageal stricture: In patients with reflux symptoms, organic stricture occurs in a few cases, resulting in dysphagia, painful swallowing, and vomiting after eating. (3) Hernia sac impaction: usually seen in paraesophageal hernia. If a patient with hiatal hernia has sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage, it suggests acute impaction.3. Symptoms of hernia sac compression When the hernia sac is large and compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitation, cough and cyanosis. When the esophagus is compressed, esophageal stagnation or difficulty in swallowing can be felt behind the sternum. Most of type I can be cured after conservative medical treatment; surgery is required when drug therapy is ineffective, and all the remaining types require surgical treatment. The traditional surgical method is transthoracic or transabdominal open surgery. Transthoracic surgery has a large chest incision, heavy cardiopulmonary interference, high anesthesia requirements, and most of them can only perform esophageal fissure repair. Performing fundoplication requires a 250px long incision in the diaphragm to complete the short gastric vessels, and damage to the diaphragm can also have a significant impact on respiratory function. In 1956, Nissen performed the world’s first fundoplication, pioneering the surgical treatment of GERD, and in 1991 Dallemagne first reported (laparoscopic Nissen fundoplication, LNF), thus introducing the procedure into the minimally invasive era. Compared with traditional surgery, LNF has the advantages of less trauma, clear field, fewer complications and faster recovery. Patients can tolerate the surgery as long as they can tolerate general anesthesia, and only 4-5 operating holes of about 0.5 – 25 px in length are established in the upper abdomen to free and expose the esophageal fissure, restore the gastric fundus into the abdominal cavity, and intermittently suture both sides of the diaphragmatic foot below the esophagus to narrow the esophageal fissure. For larger esophageal fissures, patch repair is often required. After the repair of the fissure is completed, the fundus is then folded to prevent esophageal reflux. In developed countries, laparoscopic esophageal hiatal hernia repair and fundoplication has been considered the gold standard for the treatment of esophageal hiatal hernia. For various reasons, this procedure has been carried out relatively late in China, especially in our region, and only a few large general hospitals in China have carried out this technique. The Department of Gastrointestinal Surgery of the People’s Hospital of Inner Mongolia Autonomous Region was established on September 6, 2011, and under the leadership of director Wang Ju, the leader of the department, the laparoscopic technology has been actively carried out. With the unremitting efforts of the whole department, laparoscopic gastrointestinal surgery is now in full swing, including radical surgery of gastrointestinal tumors, appendectomy, release of adhesive intestinal obstruction, repair of gastrointestinal perforation, and investigation and diagnosis of unexplained ascites. The successful completion of this case marks another new step of minimally invasive laparoscopic surgery in our hospital. We will vigorously develop this technology to provide safe, standardized and minimally invasive medical services to more patients!