Introduction: The use of prosthetic mesh in laparoscopic repair of large hiatus hernias remains controversial. Clinical and quality of life outcomes of a randomized control trial (RCT) of mesh versus suture repair previously showed few differences at early follow-up. This study evaluated long-term quality of life outcomes from that trial. Methods: A prospective, multicentre, double blind RCT assessed three methods of repair for large hiatus hernias: sutures-only vs absorbable mesh vs non-absorbable mesh. Quality of life was assessed using the Short-Form 36 (SF-36) questionnaire which was completed preoperatively and then at 3, 6, 12 months following surgery and annually thereafter. Patients who completed the questionnaire up to 5 years after surgery were included in this analysis. SF-36 outcomes were compared across the 3 repair techniques, and to earlier baseline and 12-month outcomes. Results: 126 patients were randomized – 43 - suture-only, 41 - absorbable mesh and 42 - non-absorbable mesh. Questionnaires were completed by 118 patients preoperatively, 115 at 12 months and 98 at 5 year median term follow-up. There were no significant differences between the repair techniques for the subscale and composite scores at 5-year follow-up. The mental component score improved significantly after surgery and was sustained across 5 years for all techniques. The physical component score also improved significantly but was lower at 5-years compared to the 12-month follow up for both mesh groups. Conclusion: Surgical repair of large hiatus hernias provides sustained long-term improvement in quality of life. The addition of mesh does not influence quality of life.