Complications or failures of surgery for GERD and / or hiatal hernia are reported in 1-30% of patients, and will lead to re-operation in 4-13% of cases.

The symptoms are not sufficiently reliable to establish the mechanism of failure or complication but can direct further investigations to establish a therapeutic strategy. Persisting or recurrent GERD symptoms and dysphagia are the main complaints reported by 60% and 31% of patients respectively. A complete functional and morphological assessment must be performed to determine the underlying cause : recurrence of hiatal hernia of different types, and misplacement/slippage of the fundoplication are the most common morphological findings.

Treatment options, medical, endoscopic or surgical, will depend on symptoms severity and functional and /or morphological abnormalities.