Recurrent hiatal hernia was corrected in 63 patients. Analysis of the previous procedures indicated that inadequate or no fixation sutures were employed or reflux was not corrected at the previous operation, or both. Ancillary procedures including vagotomy, pyloroplasty, and gastric resection did not prevent the complications and symptoms if reflux was not corrected. The operation for recurrent hernia consisted of posterior gastropexy employing the median arcuate ligament coupled with calibration of the cardia. Results are classified as excellent to good in 81% of the cases. There were two deaths in this series for a mortality of 3.3%, contrasted to a mortality of 0.5% for 425 patients having elective repair of hiatal hernia. There has been no subsequent recurrent herniation in this series, with a follow-up extending to eight years and a mean follow-up of 3.3 years.