Outcomes of surgical management of symptomatic large recurrent hiatus hernia. 
Recurrent hiatus hernia is frequently found in patients undergoing reoperative antireflux surgery.  The objective of this study is to report perioperative complications and subjective and objective outcomes for patients who underwent reoperative intervention for symptomatic large recurrent hiatus hernia.  Retrospective review of a prospectively maintained database was performed to identify patients with large (≥ 5 cm gastric tissue above the crus) recurrent hiatus hernia who underwent reoperation after failed antireflux surgery.  Data for preoperative workup, operative procedure, and postoperative 6-month follow-up were reviewed and analyzed.  Two hundred twenty patients underwent reoperation over a 6-year period.  Forty-four patients had large recurrent hiatus hernia; 21 underwent redo fundoplication, while 23 underwent Roux-en-Y (RNY) reconstruction as remedial procedure.  Short esophagus was found in 16 cases (6 of 21 redo Collis fundoplications, 10 of 23 RNY reconstructions).  There was significant symptom improvement and high degree of satisfaction reported in both groups.  However, patients with short esophagus did better with RNY reconstruction compared with redo Collis gastroplasty.  Repair of large recurrent hiatus hernia is a technically challenging procedure; however, there is high degree of symptom resolution and patient satisfaction.  RNY reconstruction might be a better alternative in patients with short esophagus compared with redo Collis gastroplasty.