Gastrointestinal surgery: gas-bloat after fundoplication: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: gas-bloat after fundoplication

Sample item

Three weeks after a laparoscopic total fundoplication, a woman is unable to belch or vomit and has distressing abdominal bloating. Dysphagia is minimal. Which mechanism best explains her symptoms?

AOesophageal stricture caused by chronic acid exposureBGastric outlet obstruction from a pyloric strictureCEarly recurrence of the hiatus hernia above the wrapDA competent wrap that prevents venting of swallowed air

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. A competent wrap that prevents venting of swallowed air

Gas-bloat syndrome is a recognised effect of a complete (360 degree) wrap. The competent valve stops reflux but also prevents belching, so swallowed air accumulates in the stomach. A looser or partial wrap lowers the risk.

Option by option

A. Oesophageal stricture caused by chronic acid exposure
A peptic stricture would cause dysphagia, which is minimal here.
B. Gastric outlet obstruction from a pyloric stricture
Outlet obstruction would cause vomiting of food, but this patient cannot vomit at all.
C. Early recurrence of the hiatus hernia above the wrap
Recurrence of the hernia would typically bring back reflux or pain, not inability to belch.
D. A competent wrap that prevents venting of swallowed air (correct)
Correct. A tight, competent wrap blocks the reflux of gas as well as of acid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, A competent wrap that prevents venting of swallowed air. Gas-bloat syndrome is a recognised effect of a complete (360 degree) wrap.

Why is "Oesophageal stricture caused by chronic acid exposure" not the answer?

A peptic stricture would cause dysphagia, which is minimal here.

Why is "Gastric outlet obstruction from a pyloric stricture" not the answer?

Outlet obstruction would cause vomiting of food, but this patient cannot vomit at all.

Why is "Early recurrence of the hiatus hernia above the wrap" not the answer?

Recurrence of the hernia would typically bring back reflux or pain, not inability to belch.

What concept does this question test?

It tests Gastrointestinal surgery: gas-bloat after fundoplication in General Surgery. The competent valve stops reflux but also prevents belching, so swallowed air accumulates in the stomach. A looser or partial wrap lowers the risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: gas-bloat after fundoplication?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.