The collective term "recurrent hiatus hernia" groups the pseudo-recurrent lesions after inappropriate surgery together with true recurrencies. An early recurrency can often be attributed to surgical technique, a late recurrency is usually biological in nature. The manifold pathophysiology of these cases is dominated by an intercurrent relux, dysphagia or paraoesophageal stomach volvulus. A decision to operate must, because of the important technical risks inherent, be made only after fully exhausting the conservative alternatives. The reoperation requires surgeon specially qualified for the task, with experience in thoraco-abdominal procedures. Approaches and alternative operating techniques are discussed with reference to personal experience from 56 cases.