食管裂孔扩大、膈食管韧带松弛、膈肌脚薄弱及 His 角钝化是食管裂孔疝主要解剖病理改变。针对以上改变，腹腔镜下食管裂孔疝修补及抗反流手术需充分游离食管并恢复腹腔段食管长度，可靠缝合修补膈肌脚，必要时使用补片加强，根据食管动力选择Nissen、Toupet 或Dor术式重建抗反流屏障，并通过固定技术形成稳定的抗反流结构

The main anatomical and pathological changes of hiatal hernia are as follows: enlargement of the esophageal hiatus, loosening of the phrenoesophageal ligament, weakness of the diaphragmatic crura, and obturation of the angle of His. In response to the above changes, laparoscopic hiatal hernia repair and antireflux surgery require sufficient mobilization of the esophagus to restore the length of the intra-abdominal esophagus, reliable suture repair of the diaphragmatic crura, and mesh reinforcement when necessary. The Nissen, Toupet, or Dor procedure should be selected according to esophageal motility to reconstruct the antireflux barrier, and a stable antireflux structure should be formed through fixation techniques.