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.