Abstract:
Background: Laparoscopic hiatus hernia repair is widely used for the management of hiatal hernias, but long-term recurrence remains a major concern. Evidence regarding predictors of recurrence, particularly in routine single-centre practice, remains limited. This study evaluated recurrence and functional outcomes after laparoscopic hiatus hernia repair in a single-centre cohort.
Methods: A retrospective cohort study was conducted at Wirral University Teaching Hospital NHS Foundation Trust, United Kingdom, including all consecutive adult patients who underwent primary or revisional hiatus hernia repair between 1 January 2014 and 31 January 2024. The primary outcome was postoperative hernia recurrence documented on imaging or endoscopy. Secondary outcomes included postoperative complications, length of stay, intensive care unit admission, 30-day remission, mortality, dysphagia, proton pump inhibitor (PPI) use, and reflux symptoms at 6 months. Time-to-event outcomes were analysed using Kaplan–Meier methods, and multivariable logistic regression was used to identify factors associated with recurrence.
Results: A total of 216 patients underwent hiatus hernia repair, including 201 primary repairs and 15 revisional procedures. Median age was 62 years, 63% were female, and median body mass index was 29.4 kg/m². Fundoplication was performed in 93% of cases, and mesh reinforcement was used in 6%. Postoperative complications occurred in 35% of patients, although most were minor.. At 6 months, dysphagia was reported in 14% of patients, while PPI use decreased significantly from 94% preoperatively to 40% postoperatively (p < 0.001). Hernia recurrence occurred in 19% of patients, with a median time to recurrence of 10 months. Reoperation for recurrence was required in 18 patients. On multivariable analysis, revisional surgery was independently associated with recurrence (OR 9.86, 95% CI 2.17–55.1; p = 0.003), whereas age, sex, body mass index, mesh use, operative approach, and fundoplication type were not significantly associated with recurrence.
Conclusion: Laparoscopic hiatus hernia repair was associated with meaningful functional improvement, including reduced postoperative PPI use and generally favorable symptom control. However, recurrence remained an important long-term issue, occurring mainly within the first 2 years after surgery.
