DDSEP® 8 Quick Quiz

June 2019 - Question 1

Q1. A 56-year-old female with a BMI of 42 (kg/m2), diabetes, and hyperlipidemia presents with a 5-cm hiatal hernia. She has symptoms of heartburn during the day and significant nocturnal regurgitation such that she is sleeping in a recliner at night.

What surgical option would be most effective in this patient?

Hiatal hernia repair with Nissen fundoplication

Hiatal hernia repair with Dor fundoplication

Magnetic sphincter augmentation

Hiatal hernia repair with gastric bypass

Gastric sleeve

Q1. Correct Answer: D

The severe reflux may be due to the hiatal hernia and worsened by the obesity. This patient has medically complicated obesity and thus bariatric surgery is an option. A gastric bypass in this situation offers the best anti-reflux procedure for this patient. A fundoplication in the setting of obesity has a higher rate of recurrence of symptoms (Answers A, B). While a gastric sleeve is an option for the obesity, a gastric sleeve (Answer E) may cause de novo reflux or worsen pre-existing symptoms. Magnetic sphincter augmentation (Answer C) has demonstrated promising results in patients with a BMI less than 35 and hiatal hernia less than 3 cm. Data are not available for patients with higher BMIs.

1. Abdelrahman T, Latif A, Chan DS, et al. Outcomes after laparoscopic anti-reflux surgery related to obesity: A systematic review and meta-analysis. Int J Surg. 2018 Mar;51:76-82.
2. Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015 Sep 28;21(36):10348-57.

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