Reflux related conditions which include Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR) can cause a wide range of mild to severe symptoms. Both conditions can be challenging to diagnose and treat with the mainstay of therapy continuing to be medication. Though these diseases can exist in isolation there is a distinct population of patients that have both conditions and also a distinct population in which fundoplication with or without hiatal hernia repair may be beneficial. Much debate continues surrounding the appropriate patient to consider for surgical evaluation. This expert lecture will be cross-specialty examination of when to consider referring reflux patients for surgical evaluation.