Background <p>Absorbable synthetic meshes have gained increasing acceptance for crural reinforcement during hiatus hernia (HH) repair because their safety profile and the potential of reducing recurrence rates. Bio-A^® (Gore Medical, Newark, DE, USA) and Phasix-ST^® (C.R. Bard, Inc./Davol, Inc., Warwick, RI, USA) are the most commonly used meshes. While previous single-arm studies have been published, there are no articles reporting the comparison between Phasix-ST^® vs. Bio-A^®.</p> Aim <p>Compare safety, efficacy, recurrence rates, and quality of life after laparoscopic HH repair and cruroplasty reinforced with either Bio-A^® or Phasix-ST^® mesh.</p> Methods <p>Retrospective multicenter study (September 2011- December 2024). All patients that underwent minimally invasive HH repair with Phasix-ST^® or Bio-A^® reinforced cruroplasty and Toupet fundoplication were included.</p> Results <p>Overall, 271 patients were included. Bio-A^® reinforcement was utilized in 46.8% of patients. The median follow-up time was 94 (IQR 21) months for Bio-A^® and 51 (IQR 17) months for Phasix-ST^® mesh. Hernia recurrence was diagnosed in 10.1% of patients with similar rates for Phasix-ST^® vs. Bio-A^® (7.8% vs. 12.6%; <i>p</i> = 0.28). The regression analysis showed that Phasix-ST^® (HR 0.66), ‘keyhole’ configuration (HR 0.81), hernia type III-IV (HR 1.38), and recurrent HH (HR 1.27) were not independent predictor or protective factors for recurrence. The 55-month recurrence free probability for Bio-A^® vs. Phasix-ST^® was comparable (86.2% vs. 91.8%; <i>p</i> = 0.132).</p> Conclusions <p>This study shows that Bio-A^® and Phasix-ST^® are equally safe for crural reinforcement during HH repair. Due to the longer absorption rate, Phasix ST^® might presumably confer enhanced hiatal protection early in the course of the follow-up.</p>