Severe Heartburn in Surgery — 52yo Man | General Surgery | SMLE Q#1327
SMLE Question #1327
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 52-year-old man (BMI 44 kg/m²) has long-standing GERD with severe heartburn, nocturnal regurgitation, and chronic cough despite high-dose proton pump inhibitor therapy and lifestyle measures. Upper endoscopy shows Los Angeles grade C–D esophagitis and a 4-cm sliding hiatal hernia; biopsies show no dysplasia. Esophageal manometry is normal, and 24-hour pH monitoring confirms marked acid reflux. He requests bariatric surgery. What is the most appropriate bariatric procedure?
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