Abstract:Hiatal hernia (HH) is highly prevalent in individuals with obesity and is closely associated with gastroesophageal reflux disease (GERD), making it a common and clinically important comorbidity in metabolic bariatric surgery (MBS). Currently, standardized diagnostic and therapeutic strategies for obese patients with different types of HH remain lacking. To improve the standardization and consistency of HH management during MBS in China, the Chinese Society for Metabolic and Bariatric Surgery, together with multiple academic societies, organized 93 national experts to develop a consensus based on the latest evidence and clinical experience. The consensus addresses 12 key issues, including preoperative evaluation, intraoperative diagnosis and differentiation, the necessity of dissecting tissues around the gastroesophageal junction, strategies for concomitant repair, procedure selection according to HH subtype, and reinforcement or fixation of the gastric sleeve. This consensus aims to provide evidence-based guidance for diagnosis, classification, procedure selection, and intraoperative management of HH in obese patients undergoing MBS. It also highlights the current limitations in available evidence and emphasizes the need for further high-quality studies to optimize future clinical guidelines.