Larger hiatal hernias substantially increase the risk of revision after robotic repair, informing surgical decision-making.

• The 5-year revision rate ranges from 0% to 5.7%, with a weighted average of about 3.2%.
• Large or giant hernias (≥5 cm) show revision rates up to 30%, while small hernias (<5 cm) have rates of 0-2%.

Consider assessing hernia size carefully and consider mesh reinforcement to reduce revision rates.

• Mesh-reinforced repairs had lower revisions (2-4%) compared to non-mesh (6-8%), although reporting varied significantly across studies.