# Situation: A 41-year-old man with long-standing gastroesophageal reflux disease (GERD) and a large sliding hiatal hernia is being prepared for laparoscopic fundoplication. A coronary stent was placed 5 months ago. After fundoplication he asks why he cannot burp and feels bloated after meals. Which explanation is MOST accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630471  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 41-year-old man with long-standing gastroesophageal reflux disease (GERD) and a large sliding hiatal hernia is being prepared for laparoscopic fundoplication. A coronary stent was placed 5 months ago.

After fundoplication he asks why he cannot burp and feels bloated after meals. Which explanation is MOST accurate?

## 보기

1. Gas from the laparoscopy stays in the bowel for weeks
2. The stomach was made smaller, so it fills with gas quickly
3. Swelling at the diaphragm opening traps gas in the chest
4. A wrap at the lower esophagus stops air from coming up **✔ 정답**

**정답: 4**

## 해설

In fundoplication, the upper stomach is wrapped around the lower esophagus to strengthen the barrier against reflux. The same wrap makes it hard to belch or vomit, so swallowed air collects in the stomach (gas-bloat). Temporary dysphagia is also common after the operation.

## 심화 해설

What fundoplication does
In fundoplication, the upper part of the stomach, the fundus, is wrapped around the lower esophagus and sutured in place. The wrap strengthens the barrier at the lower esophageal sphincter so that stomach contents cannot flow back into the esophagus. When a hiatal hernia is present, it is reduced and the hiatus is repaired at the same time. The same wrap that prevents reflux also makes it hard to belch or vomit, so swallowed air collects in the stomach and causes gas-bloat.

Gas-bloat syndrome
After the operation, air swallowed during eating and drinking cannot easily escape upward. The client feels fullness, bloating, and abdominal discomfort after meals and may be unable to burp. This is called gas-bloat syndrome. It usually improves over weeks to months as the wrap loosens slightly and the client adjusts. Temporary dysphagia is also common after surgery because of swelling around the wrap.

| Explanation | Accurate? | Reason |
| --- | --- | --- |
| Laparoscopy gas stays for weeks | No | Carbon dioxide is absorbed within days |
| Stomach was made smaller | No | That describes bariatric surgery, not fundoplication |
| Swelling at the diaphragm traps gas in the chest | No | The repair does not trap gas in the chest |
| Wrap at the lower esophagus stops air coming up | Yes | Explains inability to belch and bloating |

Why the distractors are wrong
The carbon dioxide used to inflate the abdomen during laparoscopy is absorbed within a few days and may cause shoulder pain, but it does not explain an inability to belch. Fundoplication does not reduce the size of the stomach; that is bariatric surgery. The hiatal repair does not trap gas in the chest; the issue is air in the stomach that cannot escape upward.

Watch out! Postoperative shoulder pain from laparoscopy gas is a real and commonly tested effect, which makes the first option sound familiar. Match the explanation to the specific complaint: inability to burp points to the wrap.

Client teaching
The nurse teaches the client to eat small, frequent meals slowly, chew well, avoid carbonated drinks, chewing gum, and drinking through straws, which add swallowed air, and to walk after meals. Persistent difficulty swallowing or severe bloating should be reported. Key point! After fundoplication, the wrap prevents belching and causes gas-bloat; teach measures that reduce swallowed air.

## 임상 시나리오

After FundoplicationGas-bloat and inability to belch
The fundus is wrapped around the lower esophagus to stop reflux; a hiatal hernia is repaired at the same time.

The wrap also blocks belching and vomiting, so swallowed air causes gas-bloat. Temporary dysphagia is common.

Teach small, slow meals, no carbonated drinks, straws, or gum, and walking after meals.

CautionReport persistent dysphagia or severe bloating; laparoscopy gas is absorbed within days and is not the cause.

## 핵심 개념

- **Fundoplication** — Surgery that wraps the gastric fundus around the lower esophagus to prevent reflux.
- **Gas-bloat syndrome** — Bloating and inability to belch after fundoplication because air cannot escape upward.
- **Hiatal hernia** — Protrusion of part of the stomach through the diaphragm's esophageal opening into the chest.
- **Dysphagia** — Difficulty swallowing.

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