When should I consider referring a patient with a hiatal hernia for surgical evaluation?

Consider referring a patient with a hiatal hernia for surgical evaluation if they have a confirmed diagnosis of acid reflux (GORD) with symptoms that are either not responsive to medical treatment or if they are considering surgery as an alternative to long-term acid suppression therapy.

Specifically, referral to a specialist service should be considered for people with gastro-oesophageal symptoms that are non-responsive to treatment or unexplained after initial primary care assessment, or for those with suspected GORD who are thinking about surgery.

In adults, laparoscopic fundoplication may be considered for patients with confirmed acid reflux who have adequate symptom control with acid suppression but do not wish to continue therapy long term, or who cannot tolerate acid suppression therapy.