Esophagopleural fistula (EPF) following laparoscopic hiatal hernia repair is a rare clinical complication, characterized by difficulty in early diagnosis and a high mortality rate. This article reports the diagnostic and therapeutic course of a 76-year-old female patient who developed EPF after undergoing laparoscopic hiatal hernia repair combined with Nissen fundoplication. The etiology, diagnosis, and management strategies are further analyzed in conjunction with the existing literature. This case suggests that early postoperative symptoms such as high fever and dyspnea should raise a high index of suspicion for this complication. Prompt diagnostic evaluation, including thoracic drainage or oral contrast-enhanced computed tomography, is essential for establishing the diagnosis. Comprehensive conservative management—including fasting, gastrointestinal decompression, thoracic drainage, anti-infective therapy, and nutritional support—can facilitate fistula healing and represents an effective treatment approach.