The management of recurrent hiatal hernia: a single-center retrospective study

Hiatal hernia (HH), characterized by gastric mucosa displacement > 2 cm above the diaphragm, presents significant challenges with recurrence rates ranging from 10 to 60%. This study aims to evaluate the outcomes of the revisional surgery and establish a practical management flowchart for recurrent HH.

A retrospective, single-center, consecutive case series was conducted at Beijing Chaoyang Hospital. Data were collected from the patients who underwent revisional surgery for recurrent HH between June 2020 and August 2024. Variables included baseline demographics, patient characteristics, preoperative symptoms, surgical history, recurrence details, operative specifics, comorbidities, and both short-term (90-day morbidity and mortality) and medium-term (29-month follow-up) outcomes. Follow-up assessments were performed at 1, 6, and 12 months postoperatively, and annually thereafter.

Twenty-three patients (10 males, 13 females; mean age 61.7 years; mean BMI 24.0 kg/m²) underwent laparoscopic revisional surgery for recurrent HH. Primary surgical interventions included Belsey repair (13%), open surgery (21.7%), and laparoscopic repair (65.2%). Intraoperative findings indicated left-anterior recurrence in 52.2% of cases and sliding HH in 34.8%. All procedures were completed laparoscopically, except for one that was converted to open surgery. No 30-day perioperative complications or mortality were observed. At a median follow-up of 29 months, no recurrences or mesh-related complications were detected. Postoperative symptoms included indigestion (34.8%), bloating (26.1%), and regurgitation (4.3%). Additionally, 75% of patients discontinued proton pump inhibitors, and 95% reported satisfaction with the revisional surgery.

Laparoscopic revisional surgery for recurrent HH is safe and effective, providing significant symptoms relief and high satisfaction with minimal complications. Individualized management and careful patient selection are essential for the favorable results.