Background: Recurrence after large hiatus hernia repair has been reported as high as 55%. A mesh reinforced repair is thought to reduce risk of recurrence and improve clinical outcomes. Early and medium-term outcomes from our randomized control trial showed no differences between suture-only, absorbable mesh and non-absorbable mesh repair. This study aims to extend follow-up to a minimum of 10 years. Methods: A multicentre prospective double-blind RCT was performed comparing 3 different repair techniques for large hiatus hernias; suture-only versus absorbable mesh versus non-absorbable mesh. Hernia recurrence was assessed by routine barium X-ray or endoscopy at 3 – 4 years. Clinical symptom were sent to patients with at least 10-year follow-up. Results: 126 patients were enrolled in the original study – 43 suture-only, 41 absorbable mesh, and 42 non-absorbable mesh. As previously reported, at 5-year follow up, a recurrent hernia (of any size) was identified in 39.3% of suture-only repair, 56.7% -absorbable mesh, and 42.9% - non-absorbable mesh. Symptom outcomes were available at long-term follow-up (mean 14.6 years) for 45.1% of patients. There were no differences in symptoms between repair techniques. There was significant improvement across the entire cohort in heartburn (2.24 vs 1.9) severity scores compared to preoperative state. Overall satisfaction was high (8.06 out of 10). Conclusion: Surgical repair of large hiatus hernias provides effective and sustained improvement. We found no advantages for mesh repair beyond 10 year follow-up. The long-term outcomes for this study do not support mesh repair for large hiatus hernias.