OBJECTIVE: To compare reflux symptoms, Zenker's diverticulum recurrence, and clinical outcomes in patients with and without a history of hiatal hernia who underwent Zenker's diverticulotomy (ZD). STUDY DESIGN: Single institution retrospective review. SETTING: Tertiary care academic hospital. METHODS: A retrospective review of patients with and without a history of hiatal hernia who underwent ZD via an open stapler, rigid endoscopic CO RESULTS: A total of 426 patients were included in the study, 97 (22.8%) of which had a history of hiatal hernia. Eleven patients (11.3%) with a history of hiatal hernia had undergone Nissen fundoplication prior to ZD. Patients with a history of hiatal hernia showed less symptomatic improvement postoperatively. Significant differences were noted in the change in the Eating Assessment Tool (EAT-10) (P <
.01) and Reflux Symptom Index (RSI) (P = .03) where patients without a history of hiatal hernia improved more than hiatal hernia patients. Despite these differences in symptom relief, rates of postoperative complications and rates of recurrence did not significantly differ between groups. The median time to recurrence was similar for both groups. CONCLUSION: Patients without a history of hiatal hernia had significantly larger improvements in EAT-10 and RSI scores compared to patients with a history of hiatal hernia. However, these differences in scores may not represent clinically meaningful differences. There were no significant differences in postoperative adverse events or in recurrence of the Zenker's diverticulum between groups.