This report presents a case of severe hiatal hernia caused by advanced-age thoracic deformity, successfully treated with single-port thoracoscopic minimally invasive repair. Nursing interventions were tailored to the patient’s condition, with preoperative emphasis on aspiration prevention, respiratory training, and postural adaptation. Postoperative care prioritized individualized positioning, tube management, dietary guidance, and rehabilitation exercises. After meticulous treatment and nursing, the patient’s symptoms—including dysphagia, dyspnea, water aspiration, food retention, chest tightness, and tachypnea—were significantly alleviated. The patient was discharged on postoperative day 11 with full recovery.