Giant esophageal hiatal hernia is a special type of esophageal hiatal hernia. The anatomical structure of the membrane changed more and more of the gastric mesentery herniated into the pleura and had more extensive adhesion to the pleura. The key point and difficulty to successfully complete the operation and avoid complications is to protect the vagus nerve, gastric mesentery, esophageal mesentery and pleura in the operation of giant esophageal hiatal hernia. Using the theory of membrane anatomy, understanding the changes of the anatomical structure of the membrane on the giant esophageal hiatus is the technical key point to successfully complete the operation and avoid injury. In this paper, the author puts forward his personal experience based on the practice of membrane anatomy theory in the operation of giant esophageal hiatal hernia.