Conclusion  In primary intervention, recurrence of hiatal hernia is more likely the larger the HSA is. The size of the hiatus is a major contributing factor to the possibility of reherniation. After failed primary hiatal closure, the size of the hiatal defect is no marker for the possibility of reherniation. Content Type Journal ArticleDOI 10.1007/s00464-010-1308-3Authors Oliver O. Koch, Department of General Surgery, General Hospital Zell am See, Paracelsusstraße 8, 5700 Zell am See, AustriaKai U. Asche, Department of General Surgery, General Hospital Zell am See, Paracelsusstraße 8, 5700 Zell am See, AustriaJohannes Berger, Division of Clinical Psychology, General Hospital Zell am See, 5700 Zell am See, AustriaEva Weber, Department of General Surgery, General Hos...