Reoperation after hiatal hernia repair is uncommon but closely linked to surgical technique, with significant implications for patient selection.

• Among 1,876 surgeries, only 2.6% required a reoperation, typically within the first year (median 348 days).
• Fundoplication resulted in lower reoperation rates (1.86%) compared to other techniques (2.99%).

Using fundoplication may reduce recurrence risk, while mesh utilization could indicate higher complexity and likelihood of reoperation.

• Mesh reinforcement showed higher reoperation rates (3.04% vs. 2.03% without mesh).