Background and Aims Laparoscopic hiatal hernia (HH) repair with mesh placement has become the primary surgical method for the treatment of HH due to its advantages of minimal trauma, rapid recovery, and fewer complications. However, the technique for mesh placement and fixation remains a challenge. This study was to introduce a novel method for HH mesh placement and explore its clinical application efficacy.Methods The clinical data of 120 patients who underwent laparoscopic HH repair at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were retrospectively analyzed. All patients included underwent mesh placement using the "contraposition and alignment" technique.Results The average operative time for the whole group of patients was (112±27) min, and the average length of postoperative hospital stay was (4.5±2.2) d. There were no deaths during the perioperative period. Early postoperative complications included dysphagia in 7 cases, with 5 cases achieving relief after 2 weeks and 2 cases still complaining swallowing difficulties at 4 weeks after operation, which were alleviated with gastroscopic balloon dilatation; postoperative urinary retention in 2 cases, which were relieved after symptomatic treatment with indwelling catheter; postoperative intra-abdominal bleeding in one case, which was managed with emergency laparoscopic exploration and hemostasis; postoperative bowel obstruction in 2 cases, which were cured with conservative treatment. The median follow-up time was 26 months, with 14 cases (11.7%) lost to follow-up. Among the followed-up patients, 5 cases complained clinical symptoms that did not significantly improve compared to preoperative conditions, while the rest of the patients reported complete or partial improvement in clinical symptoms. No cases of anatomical recurrence were observed in the followed-up patients. Furthermore, none of the followed-up cases experienced mesh-related complications such as mesh displacement, infection, and mesh erosion into the esophagus or major blood vessels.Conclusion The use of the "contraposition and alignment" technique for mesh placement in laparoscopic HH repair is safe and effective. This method is straightforward, easy to implement, and suitable for clinical promotion.