The Nissen-Hill hybrid repair was devised to combine the relative merits of its component treatments for the treatment of gastric reflux disease and hiatal hernia, with the ultimate goal of increased durability. For paraesophageal hernia, Barrett’s esophagus, and gastroesophageal reflux disease, it has been found to be safe, effective, and long-lasting in various short series. The findings in this study were based on the initial 500 fixes for all causes. Indication-agnostic retrospective evaluation of the 1st 500 consecutive Nissen-Hill hybrid repairs performed between March 2006 and December 2016. Manometry, radiographic imaging, and pH testing were all performed before and at predetermined intervals following the repair to evaluate 3 different aspects of patient satisfaction. There was 500 patients total, followed by a mean of 6.1 years. Surgery was performed for recurrent hernia repair in 67 (13.4%), paraesophageal hernia in 202 (40.4%), and GERD in 231 (46.2%). Approximately 63% of the population was made up of women, and the average age was 59. Nearly all (492, or 98%) were treated with non-invasive techniques. There was 1 patient who died within 30 days following surgery (0.2% mortality rate), whereas the rate of significant complications was 4%, and the median duration of stay was 2 days. After a median follow-up of 7.3 months, 390 patients who had pre- and post-operative pH testing saw their median DeMeester scores drop from 45.9 to 2.7. All median quality of life scores increased during the long-term follow-up (229 responses): The Impact of Reflux and Dyspepsia on Quality of Life Proton pump inhibitor use decreased from 460 (92%) to 50 (10%), resulting in improvements of 4.1 (Altered Perception of Taste), 6.9 (Health-Related Quality of Life Due to Gastroesophageal Reflux Disease), and 37.5% (Impaired Swallowing) in those metrics. Reoperation was necessary for 14 patients (3.0%). After 5 years, the Nissen-Hill hybrid repair has proven to be a safe and successful option, with excellent symptomatic and objective outcomes and minimal recurrence rates.