For patients with hiatal hernia who present with significant symptoms, show poor response to medication, or have complications, surgery is the primary treatment. During the procedure, particular attention must be paid to the meticulous dissection and preservation of the anterior and posterior vagal trunks, the left and right inferior phrenic arteries, the branches of the left gastric artery, and the periesophageal vascular network, in order to avoid postoperative complications such as swallowing dysfunction, delayed gastric emptying, or bleeding. In each surgical step, the principles of meticulous dissection, direct visualization, avoidance of blind electrocoagulation, and excessively deep suturing should be adhered to. Intraoperative techniques guided by the concept of precise anatomy not only improve the quality of anatomical reduction in hernia repair but also significantly enhance patients' postoperative quality of life and long-term outcomes.