Hiatal hernia (HH), as an important etiology of gastroesophageal reflux disease (GERD), has controversies such as confusion and inconsistent interpretation in preoperative examination protocols, which lack standardization and affect the efficacy and safety of surgery. Therefore, the Expert Working Group on Diagnosis and Treatment of Gastroesophageal Reflux Disease of the Surgery Physicians Branch of the Chinese Medical Doctor Association, together with multiple academic societies, organized 104 domestic experts to conduct offline meetings and online voting. With reference to the latest domestic and foreign guidelines, consensuses and clinical research results, an expert consensus was formed on 7 core issues, including 24-hour esophageal pH monitoring, high-resolution esophageal manometry, gastroscopy, upper gastrointestinal radiography, chest and abdominal computed tomography, gastroesophageal junction contrast-enhanced ultrasound, and other auxiliary examinations. This consensus aims to provide a reference for the selection of preoperative examinations for anti-reflux surgery related to hiatal hernia in China. However, the current research evidence is limited with low evidence levels. In the future, more high-quality studies are still needed to promote the precision and standardization of preoperative examinations for HH complicated with GERD, and to provide more optimized diagnosis and treatment strategies for patients.