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BACKGROUND: Barium swallow is considered essential in the preoperative assessment of gastroesophaeal reflux disease and hiatal hernias. The objective of this study was to investigate the effective value of a barium swallow if complementary to the commonly recommended endoscopy before laparoscopic antireflux and hiatal hernia surgery. METHODS: We prospectively evaluated 40 consecutive patients who were tested with preoperative barium swallow and endoscopy before laparoscopic surgery for gastroesophageal reflux disease and/or symptomatic hiatal hernia. Results regarding the presence and the type of hiatal hernia found by barium swallow and endoscopy were correlated with the intraoperative finding as the reference standard. RESULTS: Intraoperative findings revealed 21 axial, 7 paraesophageal, and 12 mixed hiatal hernias. Barium swallow and endoscopy allowed the diagnosis of hiatal hernia in 75% and 97.5%, respectively (p = 0.003). The correct classification of hiatal hernia was confirmed in 50% by barium swallow and 80% by endoscopy (p = 0.005). CONCLUSIONS: Although barium swallow is recommended as an important diagnostic tool in the workup before surgical antireflux and hiatal hernia therapy, our results suggest that if mandatory endoscopy is performed preoperatively, a barium swallow does not provide any further essential information. It seems that barium swallow can be omitted as a basic diagnostic test before primary laparoscopic antireflux and hiatal hernia surgery.