Abstract:Hiatal hernia (HH) is an important etiological factor of gastroesophageal reflux disease (GERD). However, the preoperative evaluation strategies for HH-related antireflux surgery remain insufficiently standardized, and controversies still exist regarding the indications, combinations, and interpretation of different diagnostic modalities, which may affect surgical decision-making and postoperative outcomes. To standardize the preoperative assessment of HH-related antireflux surgery in China, the Expert Working Group on Gastroesophageal Reflux Disease of the Chinese Medical Doctor Association, together with multiple academic societies, convened 104 experts nationwide to develop consensus recommendations through face-to-face discussions and Delphi voting. Based on the latest international and domestic guidelines, consensus statements, and current evidence, recommendations were established for seven core aspects of preoperative evaluation, including 24-hour esophageal pH monitoring, high-resolution esophageal manometry, endoscopy, upper gastrointestinal contrast studies, chest and abdominal computed tomography, gastroesophageal contrast-enhanced ultrasonography, and other adjunctive examinations. This consensus emphasizes a multidimensional preoperative assessment system centered on symptoms, function, and anatomy, advocates individualized and stratified diagnostic strategies, and highlights the importance of multidisciplinary collaboration in the management of complex cases. The aim of this consensus is to provide practical guidance for the standardized preoperative evaluation of HH-related antireflux surgery. Given the overall limited quality of current evidence, more high-quality research is still needed in the future to further optimize the preoperative assessment system.