Outcomes of Laparoscopic Hiatal Hernia Repair: A Three-Year Follow-Up Study From a UK Tertiary Centre

Background: Laparoscopic hiatal hernia repair is standard for symptomatic para-oesophageal and selected sliding hernias. International guidance supports elective repair for symptomatic disease; however, reported radiological recurrence rates vary, and their clinical relevance is debated. Methodology: Retrospective cohort of 126 adults undergoing elective laparoscopic hiatal hernia repair at University Hospitals Birmingham (2016-2020). All patients underwent standard laparoscopic reduction, posterior cruroplasty and Nissen (360°) fundoplication. No mesh reinforcement was used in any case. Follow-up at 12 and 36 months captured overall symptom relief, dysphagia improvement, radiological recurrence, redo surgery, and symptomatic patients without radiological recurrence. Outcomes are intention-to-follow (N = 126) and reported as n (%) with 95% confidence intervals (CIs). Results: The median age was 59 years. At 12 months, 111/126 (88.1%) reported overall symptom relief, and 98/126 (77.8%) reported dysphagia improvement. At 36 months, 103/126 (81.7%) and 88/126 (69.8%), respectively. Radiological recurrence occurred in 15/126 (12.0%) at 12 months and 28/126 (22.2%) at 36 months. Symptomatic recurrence requiring redo surgery occurred in 2/126 patients (1.6%) at 12 months and 9/126 (7.1%) at 36 months; asymptomatic recurrences were 13/126 (10.3%) and 19/126 (15.1%), respectively. Symptomatic patients without radiological recurrence were 3/126 (2.4%) at 12 months and 4/126 (3.2%) at 36 months. Conclusions: Laparoscopic repair provides a reliable symptom control outcome through three years. Radiological recurrence is relatively common but frequently asymptomatic; only a minority (≤10%) require redo surgery. Long-term, symptom-led follow-up is warranted.