Hiatal disruption is one of the common mechanisms of failure after Nissen fundoplication. We investigated the correlation between various diaphragm stressors and disruption of the diaphragmatic closure. Thirty-seven patients with a hiatal hernia recurrence of 2 cm or greater, as proven by esophagram, endoscopy, or operative findings, were included. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire for the study group and a control group of 50 patients without hiatal hernia recurrence. Logistic regression was used to determine the significant predictors of hiatal hernia recurrence. Three predictors emerged in the final model: weight lifting (PPP<0.2472). Of these, only vomiting and weight lifting were significant. The odds ratio for weight lifting is OR=3.662 (95% CI: 1.256–10.676), and for vomiting it is OR=4.938 (95% CI: 1.154–21.126). Vomiting or heavy weight lifting is a significant predictor of hiatal hernia recurrence.