Introduction: The treatment of Hiatal Hernias (HH) type III and IV is surgical. There is controversy about reinforcement with mesh. Our objective was to compare the long-term results between the use or not of prosthetic reinforcements. Materials and Methods: Prospective cohort of 95 patients with HH type III and IV, between 1997 and 2015 at the Clinical Hospital of the University of Chile. Pre and postoperative radiological, endoscopic and functional characteristics were evaluated. Recurrence defined as a recurrence greater than 3 cm. Statistical analysis with chi2 and U-Mann-Whitney test. p-value < 0.05. Results: Com-plete follow-up in 82% of patients, with a mean of 117 months. In 63% of the cases, the hernia size was < 10 cm, with a mean of 9 cm. 25% presented a gastric volvulus, with an average size of 10.9 cm, being significantly larger than those who did not present (p < 0.0001). The median percentage of time with pH<4 in 24 hours was 9.6%, without encountering hernia size (R = 0.009). The mean lower esophageal sphincter pressure was 8.9 mm Hg, without connection to the size of the hernia (R = 0.0004). Mesh was removed in 41% of cases. Recurrence occurred in 29.7% of the group with prosthesis and in 28.6% of the group without mesh, without significant differences (p = 0.84). Conclusions: In long-term follow-up (> 10 years) of surgically repaired type III and IV HH, there are no differences in clinical recurrence with or without the use of mesh.