腹腔镜食管裂孔疝修补联合胃底折叠术已成为治疗中重度食管裂孔疝的标准术式，但其术中出血、术后吞咽困难、疝复发及补片相关并发症仍不容忽视。本文结合2018—2023年在中山大学附属第六医院疝和腹壁外科行腹腔镜食管裂孔疝修补联合胃底折叠术的432例中重度食管裂孔疝患者的临床资料及手术经验，系统总结上述核心并发症的防治策略。432例患者总并发症发生率为15.3%（66例）。其中术中并发症以出血最常见，30例（6.9%）；术后并发症以吞咽困难最常见，52例（12.0%）；疝复发8例（1.9%）；补片相关并发症3例（0.7%）。单因素分析显示年龄≥50岁及行Nissen折叠术是术后吞咽困难发生的相关因素（P均<0.05）。通过规范术前评估、优化术式选择、强化术中精细操作及建立阶梯化管理流程，可有效降低并发症发生率。基于精准解剖的个体化术式选择、规范化操作流程及阶梯化管理策略是降低并发症、提升手术安全性的关键。

Laparoscopic hiatal hernia repair combined with fundoplication has become the standard surgical procedure for moderate to severe hiatal hernia, but intraoperative bleeding, postoperative dysphagia, hernia recurrence, and mesh-related complications remain significant concerns. This article summarizes the prevention and management strategies for these core complications based on the clinical data and surgical experience of 432 patients with moderate to severe hiatal hernia who underwent laparoscopic hiatal hernia repair combined with fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, from 2018 to 2023. The overall complication rate in the 432 patients was 15.3% (66 cases). Among intraoperative complications, bleeding was the most common, occurring in 30 cases (6.9%). Among postoperative complications, dysphagia was the most frequent, occurring in 52 cases (12.0%). Hernia recurrence occurred in 8 cases (1.9%), and mesh-related complications in 3 cases (0.7%). Univariate analysis showed that age ≥50 years and Nissen fundoplication were associated factors for postoperative dysphagia (both P<0.05). By standardizing preoperative evaluation, optimizing surgical approach selection, strengthening intraoperative precise manipulation, and establishing stepwise management protocols, the incidence of complications can be effectively reduced. Individualized surgical strategies based on precise anatomy, standardized operative procedures, and stepwise management approaches are key to reducing complications and improving surgical safety.