Surgical strategies to prevent recurrence after hiatus hernia repair

Summary Background Surgical repair is the treatment of choice for symptomatic hiatus hernia, but it is burdened by a high recurrence rate. The efficacy of prevention strategies remains a subject of ongoing debate. Review Numerous surgical strategies have been proposed to prevent hiatus hernia recurrence. These encompass techniques to ensure adequate esophageal length through optimal axial dissection and approaches to enhance hiatoplasty durability, such as specific crurorrhaphy techniques, relaxing diaphragmatic incisions, and mesh reinforcement. Additionally, pexy techniques of the esophagogastric junction or fundus to the diaphragm are employed. More recently, platelet-rich plasma has been explored in hiatus hernia surgery for its potential to stimulate collagen production and improve healing. The technical specifics of these surgical strategies vary significantly, and their supporting scientific evidence ranges from expert opinions to randomized controlled trials. This review aims to synthesize current knowledge on surgical strategies and is intended to serve as a practical guide to improve the surgical management of patients undergoing hiatus hernia repair, with a focus on minimizing recurrence.