Abstract Background Laparoscopic cruroplasty for giant hiatus hernias utilizing non-absorbable sutures, has been demonstrated to be safe with good symptomatic relief. However, recurrence rates as high as 42% have been reported. Hiatoplasty using synthetic mesh was introduced to reduce recurrence. However, there are concerns due to complications, most notably oesophageal erosion. Due to the lack of high-quality comparative data between different types of mesh for hiatus hernia repairs, there is little evidence to guide use of mesh. We aimed to assess outcomes comparing suture cruroplasty (SC) with mesh hiatus hernioplasty (MHH) after HH repair in our unit at a busy DGH. Methods We retrospectively collected data of consecutive patients undergoing hiatus hernia repair between January 2016 and December 2021. Data was obtained from electronic patient records form hospital system. Primary outcomes assessed were recurrence and re-operation rates at follow up. Secondary outcomes assessed were peri-operative morbidity. We used PTFE coated composite (dual gore) mesh for MHH. Data were analysed using the two-tailed t-test for continuous data and χ2 or Fishers exact tests for categorical data. Level of statistical significance was set at p value of <0.05. Results 145 patients (SC= 98, MHH= 47) underwent hiatus hernia repair. Indications were paraesophageal (Type II-IV) HH in 58.62%, and large Type I HH in 41.38%. Conversion rate was 0.67%. There was no significant difference in post –operative morbidity. An outcome without postoperative complications was achieved in 77.24% of cases overall. After a mean follow-up of 17 months, hernia recurrence (10.2% versus 14.89%, p=0.42) and re-operation rates (5.1% versus 8.51%, p=0.47) were not significantly different. There were no mesh erosions. Overall, 132patients (91.03%) had relief from symptoms, 115 (79.31%) were able to stop GORD medications. Conclusions Suture cruroplasty and mesh hernioplasty produce comparable results with respect to recurrence and re-operation rates. Recurrence rates after repair are low, and are asymptomatic in most cases. A long-term follow up will enable to identify any significant future impact of method or modality of repair on patient outcome.