Patient-related risk factors associated with symptomatic recurrence requiring reoperation in laparoscopic hiatal hernia repair

BACKGROUND: Recurrent hiatal hernia remains a challenge. METHODS: For initial repairs at our center: patients with 1 repair were compared to those who required reoperation for symptomatic recurrence. Subsequently, patients who had 1 repair at our center were compared to all patients who required reoperation (including initial repair at another center). RESULTS: There were 401 repairs: 308 primary repairs at our center and 93 reoperations, 287/308 (93%) required 1 repair and 21/308 (7%) required reoperation. Comparing 1 repair versus 21 reoperations, risk factors were abdominoplasty odds ratio = 32.0 (4.1–250.6), P < .001, postoperative lifting/vomiting odds ratio = 11.6 (3.2–42.1), P < .0002, tubal ligation odds ratio = 4.9 (1.1–22.6), P < .04 and height < 160 cm odds ratio = 3.9 (1.1–13.3) P < 0.03. Comparing 287 with 1 repair versus all 93 reoperations, risk factors were post-operative vomiting odds ratio = 22.7 (2.3–218.0), P < .007, abdominoplasty odds ratio = 5.6 (1.0–31.4), P < .0495, post-operative lifting odds ratio = 5.4 (2.2–12.9), P < .0002, age < 52 odds ratio = 3.6 (1.8–7.3), P < .0003, tubal ligation odds ratio = 3.2 (1.2–8.7), P < 0.019 and height < 160 cm odds ratio = 3.0 (1.5–6.1), P < 0.003. CONCLUSIONS: Younger age, shorter stature, heavy lifting or vomiting after surgery, abdominoplasty and tubal ligation are risk factors associated with symptomatic recurrence requiring reoperation.