The indications for laparoscopic fundoplication are the same as those for open surgery: 1. Type II-IV esophageal hiatal hernia with clear diagnosis; 2. Type I with severe gastroesophageal reflux symptoms and ineffective medication or other complications; 3. Combined severe peptic esophagitis, esophageal stricture, hemorrhage, recurrent aspiration pneumonia, Barrett’s esophagus, etc. Contraindications to surgery: 1. those who cannot tolerate general anesthesia; 2. those with difficult to correct coagulation dysfunction; 3. those with a history of epigastric surgery (relative contraindication). The surgical procedure for esophageal hiatal hernia consists of two parts: plastic surgery of the esophageal hiatal hole and fundoplication. The traditional transthoracic surgery has a large incision, heavy cardiopulmonary interference, high anesthesia requirements, and most of them can only complete the repair of esophageal hiatus, while the fundoplication requires a separate incision on the diaphragm, which has a greater impact on respiratory function; although transthoracic surgery reduces cardiopulmonary interference, there is little room for operation at the top of the diaphragm and the incision is large, and many patients are reluctant to undergo surgery in the early stage of the disease because of the fear of surgical trauma. Dallemagne et al. first reported laparoscopic fundoplication in 1991, which was rapidly promoted and has now become the gold standard procedure for the treatment of gastroesophageal reflux disease and large esophageal hiatal hernia or paraesophageal hernia. In this group, the esophageal hiatal hernia was type II-IV with clear surgical indications, and all 14 cases were repaired laparoscopically to minimize the interference with the patient’s cardiopulmonary function and reduce the perioperative risk. In particular, one case in this group was an 82-year-old female patient with combined hypertension, coronary heart disease and diabetes mellitus, which required rational design and minimized the impact of surgical trauma on the body. In a prospective study of laparoscopic hernia repair in 72 patients with hernia rings ≥8 cm in diameter, Frantzides et al. performed direct suture repair in 36 cases with a recurrence rate of 22% and patch repair in 36 cases with a recurrence rate of 0. Muller2Stich et al. reported 36 cases of direct laparoscopic hernia repair with a recurrence rate of 19% and 16 cases of patch repair without any hernia recurrence. Thus, laparoscopic patch repair of giant esophageal hiatal hernia is considered superior to suture repair. In our group, three patients with hernia ring diameter >5 cm were repaired by laparoscopic patch repair, and none of them recurred after 1 to 3 years of postoperative follow-up. The efficacy of laparoscopic Nissen surgery against reflux has been reported in a large number of cases abroad and mature evaluation indexes. 838 operations for reflux esophagitis were retrospectively studied in 808 cases by Zacharoulis et al. symptoms improved. Dnaaisma et al. conducted a comparative study between laparoscopic Nissen surgery and conventional Nissen surgery and showed comparable long-term results between laparoscopic and conventional surgery. In our group, 12 cases were followed up for 1 to 3 years with satisfactory results. The incidence of complications Laparoscopic Nissen surgery has been performed abroad for more than 10 years, and its efficacy is definite, but the incidence of its surgical complications is still 1%-8%. The most common complication is postoperative dysphagia, which improves in most patients after a period of time and is initially considered to be related to postoperative edema of the gastroesophageal junction. To address this problem, the incidence of postoperative dysphagia can be reduced to some extent by using the short-loose Nissen procedure, along with careful treatment of the short gastric vessels. In addition, complications include hemorrhage, splenic injury, pneumothorax, subcutaneous emphysema, and mediastinal emphysema. We strictly grasp the indications for laparoscopic Nissen surgery, make good preoperative cardiac and pulmonary function assessment, pay attention to not over-traction of the liver and spleen during surgery; use ultrasonic knife to carefully separate the short gastric vessels; if the vessels are thick, apply titanium clips to strengthen them. There were no complications such as hemorrhage in this group. With the continuous maturation of laparoscopic technology, more and more diseases can be treated by minimally invasive surgery. Laparoscopic treatment of esophageal hiatal hernia has been proved to be a safe and effective procedure, especially because the incidence of esophageal hiatal hernia is high in the elderly, and the advantages of laparoscopy such as less trauma, faster recovery, less pain and better tolerance can be better reflected, while in terms of surgical separation and dissection, laparoscopy has the advantages of good field exposure, clear images and more suitable for precise operation. Therefore, laparoscopic fundoplication should be the preferred surgical approach for patients with surgical indications for esophageal hiatal hernia.