Background <p>The number of patients with giant hiatal hernias requiring surgery is increasing. However, there have been some concerns regarding the possible high recurrence rates. Additional gastropexy has been suggested to reduce recurrence rates. This study aimed to examine whether additional gastropexy is effective in patients with giant hiatal hernias.</p> Methods <p>We enrolled 77 patients with giant hiatal hernias who underwent laparoscopic hiatal hernia repair between June 2011 and December 2022. The patients were divided into two groups according to the presence or absence of gastropexy, the surgical outcomes and recurrence of hiatal hernia between the groups were compared.</p> Results <p>The gastropexy group included 52 patients (68%). Although the operating time was longer in the gastropexy than in the non- gastropexy group (<i>P</i> &lt; 0.01), there were no differences in the pre- and post- operative complications between the two groups. Surgery with gastropexy significantly improved symptoms, such as heartburn, reflux, chest pain, and vomiting, as well as the pathology of hiatal hernia, cardiac loosening, and esophagitis. The rates of recurrence of hiatal hernia and esophagitis were significantly lower in the gastropexy than in the non- gastropexy group (<i>P</i> &lt; 0.01 and <i>P</i> = 0.04, respectively).</p> Conclusions <p>Laparoscopic anterior gastropexy is safe and effective for preventing the recurrence of giant hiatal hernias.</p>