Incidence and timing of reoperation after hiatal hernia repair in a real-world multi-hospital cohort.

BACKGROUND

Recurrence after hiatal/paraesophageal hernia repair is variably defined, and radiographic criteria may overestimate clinically meaningful failure. We evaluated the incidence, timing, and operative predictors of recurrence, defined pragmatically as reoperation, in a large multi-hospital cohort.

STUDY

DESIGN

Retrospective cohort study of adults undergoing hiatal and/or paraesophageal hernia repair (April 2017-April 2025) using an enterprise administrative/operative database. Cases were identified using CPT codes supplemented by operative descriptors and nursing documentation. Patients with prior or concurrent bariatric surgery were excluded. The index repair was the first qualifying repair within the study window. The primary endpoint was clinically significant recurrence, defined as subsequent hiatal/paraesophageal hernia reoperation. Time-to-event was analyzed using survival models that incorporated operative factors and accounted for clustering.

RESULTS

Among 2779 repairs, 900 bariatric-associated cases were excluded, leaving 1876 index repairs across 21 hospitals and 70 surgeons. Approach was laparoscopic in 49.3% and robotic in 48.0% (open 2.0%, thoracotomy 0.7%). Mesh was used in 51.1% and fundoplication in 39.4%. During follow-up, 49 reoperations (2.6%) occurred. Time to reoperation clustered early (median 348 days [IQR 107-623]), with follow-up extending to 3023 days. In unadjusted comparisons, reoperation was less frequent after fundoplication (1.86 vs. 2.99%) and more frequent with mesh reinforcement (3.04 vs. 2.03%). In adjusted time-to-event models accounting for clustering, fundoplication was independently associated with a lower hazard of reoperation, whereas mesh use was associated with a higher hazard.

CONCLUSIONS

In routine practice, reoperation after hiatal/paraesophageal hernia repair was uncommon and concentrated within the first several postoperative years. Fundoplication was associated with lower risk of clinically significant recurrence, while mesh use identified higher-risk cases, likely reflecting operative complexity.