Long-term durability and temporal pattern of revisional surgery of laparoscopic large hiatal hernia repair

Laparoscopic repair is the preferred surgical treatment for symptomatic Large Hiatal Hernia (LHH). However, data on long-term outcomes are limited. This study aims to evaluate the 20-year follow-up results of laparoscopic LHH repair in a high-volume experienced tertiary center. Retrospective analysis of patients who underwent elective laparoscopic LHH repair between 1992 and 2008. Preoperative and perioperative data were collected. The primary endpoint was the long-term reoperation rate. Survival analyses were calculated according to the Kaplan-Meier method and compared with the log-rank test. A Cox proportional hazard model was used to investigate predictive factors of the need for revisional surgery. A total of 176 patients were included. All the procedures were performed laparoscopically, and in 5 cases (3.0%) with a robot-assisted approach. Mesh-augmented cruroplasty was performed in 26 patients (15.8%). A fundoplication was added in all patients: Nissen in 158 (89.8%), Toupet in 5 (2.8%), and Collis-Nissen in 13 (7.4%). Postoperative mean follow-up was 224.6 ± 83.3 months. Clinically significant hiatal hernia recurrence occurred in 27 (16.2%), and 18 patients (10.2%) underwent surgical revision. The median time-to-redo was 12 months (IQR 6-42 months). Overall durability without revisional surgery at 20-year follow-up was 90%. The rate of revisional surgery after LHH repair is low and is generally required within 12 months from primary surgery. Our results highlight the long-lasting effects of LHH repair at 20-year follow-up.