Hiatal hernia recurrence remains a common challenge following surgical repair, and adjunct techniques such as gastropexy have been proposed to improve gastric fixation and reduce recurrence risk. This retrospective study evaluated recurrence rates and management strategies in patients undergoing hiatal hernia repair with and without gastropexy. The addition of gastropexy was associated with a lower recurrence rate compared with repair without gastropexy, suggesting it may be a useful adjunct in selected patients.