Background: Laparoscopic repair of large hiatus hernias provides excellent clinical outcomes in symptomatic patients. However, recurrence is common and long-term follow-up (>10 years) is limited to small sample sizes. The aim of this study is to evaluate long-term clinical outcomes following repair. Methods: Patients who underwent surgical repair of a very large hiatus hernia ( 50% intrathoracic stomach) with a minimum of 10-year follow-up were identified from a prospectively collected database. A standardised questionnaire was sent to patients to identify presence and severity of symptoms, as well as overall satisfaction. Results were compared to preoperative and short-term (<12 months) outcomes. Results: Between 2000 to 2015, 321 suitable patients who underwent large hiatus repair with a minimum 10-year follow-up were identified. 137 patients (42.7%) completed and returned the questionnaire. Follow-up ranged from 10 to 24.1 (mean 15.2) years. There was a significant improvement in heartburn (5.62 vs 2.08, p < 0.001) and regurgitation (6.77 vs 2.04, p < 0.001) severity comparing preoperative to long-term follow-up results. 90 patients (65.7%) reported ongoing use of antacid medications. Other commonly reported symptoms include: dysphagia (41.6%), increased flatulence (51.8%), bloating (34.3%) and early satiety (30.7%). 110 patients (80.9%) report no ongoing or mild symptoms. Overall satisfaction was 8.15 out of 10. Conclusion: Despite high rates of recurrence in the literature, we found laparoscopic repair of large hiatus hernia provides both an effective and sustained improvement in symptoms.