Recurrence after minimally invasive hiatus hernia repair: a single-centre retrospective cohort study of clinical and functional outcomes

Abstract Background Hiatus hernia repair is associated with symptomatic improvement, although postoperative recurrence remains an important concern. This study aimed to evaluate recurrence, associated risk factors, postoperative morbidity, and functional outcomes following hiatus hernia repair. Methods This single-centre retrospective cohort study included 217 consecutive adults undergoing primary or revisional hiatus hernia repair between January 2014 and January 2024. Clinical, operative, and postoperative data were retrospectively collected. Recurrence was identified from available clinical documentation. Recurrence-free survival was evaluated using Kaplan–Meier analysis, and factors associated with recurrence were investigated using Cox proportional hazards regression. Changes in proton pump inhibitor (PPI) use at six months were assessed using McNemar’s test. Results Of 217 patients, 202 (93%) underwent primary repair and 15 (7%) underwent revisional surgery. Recurrence was documented in 40 of 213 patients (18.8%), with a median time to recurrence of 10 months (IQR 5–19). Estimated recurrence-free survival at 24 months was 82.0%. Recurrence was more frequent following revisional than primary repair (40% versus 17%). Revisional surgery was associated with increased recurrence risk in unadjusted analysis (HR 2.49, 95% CI 1.04–5.95; p = 0.040), but the association was not statistically significant after adjustment (adjusted HR 2.24, 95% CI 0.83–5.99; p = 0.11). Postoperative complications occurred in 37% of patients, and no 30-day mortality was recorded. Among 164 patients with paired data, PPI use decreased significantly from 94% preoperatively to 40% at six months ( p < 0.001). Conclusion Hiatus hernia repair was associated with a significant reduction in postoperative PPI use. However, documented recurrence affected approximately one in five patients and was more frequent following revisional surgery, although revisional repair was not an independently significant predictor after adjustment. These findings warrant cautious interpretation because of non-standardised recurrence ascertainment and incomplete follow-up data.