Objective To explore the learning curve characteristics and clinical efficacy of laparoscopic paraesophageal hernia repair based on key anatomical principles. Methods A retrospective analysis was conducted on the clinical data of 83 patients who underwent laparoscopic mesh repair of paraesophageal hernia combined with fundoplication at the Department of Hernia and Obesity Surgery, The First Affiliated Hospital of University of Science and Technology of China, between January 2021 and December 2025. The observed outcomes included postoperative recurrence rate, GERD remission rate, and incidence of postoperative complications. The cumulative sum (CUSUM) analysis method was used to plot the learning curve of paraesophageal hernia repair, and comparisons were made across different learning phases in terms of operative time, recurrence rate, complication rate, and improvement in postoperative GERD-Q scores. Results Follow-up was 22 (1-60) months, with no imaging-confirmed recurrence. The GERD-Q score decreased from 12 (6-18) preoperatively to 6 (3-14) postoperatively (Z=-10.158, P<0.001). The GERD remission rate was 94.0% (78/83), and the rate of proton pump inhibitor discontinuation was 97.6% (81/83). All 83 patients successfully underwent the surgery, with an intraoperative complication rate of 6.0% (5/83), all of which were right-sided pleural tears. The intraoperative complication rate was significantly lower in the group with identification of the infracardiac bursa compared to the group without identification (0 vs. 29.4%, P<0.001). Regarding postoperative complications, one patient (1.2%) underwent reoperation due to excessive tightness of the Nissen fundoplication. The incidence of postoperative dysphagia was 10.8% (9/83), with no statistically significant difference between the Nissen group (13.6%) and the Dor group (4.2%). The incidence of postoperative reflux was 4.8% (4/83), also showing no statistically significant difference between the two groups (both P>0.05). The CUSUM learning curve analysis identified an inflection point in 31 cases, based on which patients were divided into the learning phase (31 cases) and the proficiency phase (52 cases). The intraoperative complication rate was significantly lower in the proficiency phase than in the learning phase (1.9% vs. 16.1%, P=0.025), while there were no statistically significant differences between the two phases in terms of postoperative GERD-Q scores, dysphagia, or reflux incidence (P>0.05). Conclusion During the learning curve of laparoscopic paraesophageal hernia repair, a deeper understanding of the surgical anatomy and function of the gastroesophageal junction is required, which can achieve advantages such as a low recurrence rate, a high remission rate of GERD symptoms, and few complications.