•Hiatal hernia recurrence following surgical repair remains a significant clinical challenge
•Revisional repair is frequently required but is associated with greater technical complexity and uncertain long-term outcomes
•Objective: To evaluate perioperative safety and clinical outcomes of revisional hiatal hernia repair compared with primary repair within a community healthcare system
Retrospective review of patients undergoing hiatal hernia repair at a single community health system
Study period: February 2020 – October 2024
Inclusion criteria:
•Adult patients undergoing hiatal hernia repair
Exclusion criteria:
•Achalasia
•Concomitant magnetic sphincter augmentation
•Age <18 years
Primary outcomes:
•Readmission
•Need for further revisional surgery
•Postoperative reflux symptoms
Total patients: 181
•Primary repair: 161 (89%)
•Revisional repair: 20 (11%)
•Of 181 patients: 161 (89.0%) underwent primary repair (PR)20 (11.0%) underwent revisional repair (RR)
•90-day readmission: PR: 6/161 (3.7%)RR: 1/20 (5.0%)p = 0.781, CI 0.155–11.908
•Need for further revision (RYGB or redo hiatal hernia repair): PR: 7/161 (4.3%)RR: 5/20 (25.0%)p < 0.001, CI 2.071–25.961
•Postoperative reflux among patients with follow-up: PR: 13/138 (9.4%)RR: 4/17 (23.5%)p = 0.079, CI 0.841–10.407
Revisional hiatal hernia repair is associated with:
•Significantly higher risk of requiring additional revisional surgery
•Trend toward increased postoperative reflux symptoms
•Similar short-term readmission rates compared with primary repair
These findings suggest progressively decreasing durability with repeated hiatal hernia repair, highlighting the importance of careful patient selection and surgical strategy during primary repair.