Elias Darido, MD, FACS

In this situation, the hiatal hernia should be repaired and reinforced with bio-absorbable mesh especially if you are having symptoms like nausea, pain, vomiting and food regurgitation. Best, Dr Darido

Maintaining your weight after gastric bypass largely depends on a healthy lifestyle including daily exercise and a lean diet. Anxiety, stress and depression, unfortunately, can sabotage your attempts at maintaining a healthy weight after gastric bypass. Depression medications cause significant weight gain. Using comfort food to cope with stress is another cause of weight regain. Starvation is never a permanent solution for weight loss. A better approach is to change the quality of calories you are ingesting. Stop processed foods including sodas. Stop sugar and sweets. Choose lean cuts meat. Increase your fiber consumption especially vegetables. Make sure you are taking your multivitamin on a daily basis and check your blood vitamin levels to make sure you are not suffering from a deficiency that may affect your brain function.  Consult with your bariatric surgeon and nutritionist for advice and support. Attend bariatric support groups and work with your psychiatrist on choosing the most effective anti-depressant medications for you with the least side effects including weight gain. Other options, besides medications, for treating depression are also available and may be explored. Last but not least, exercise, yoga, deep breathing techniques ...are effective tools to elevate your mood, fight depression, increase your metabolism and maintain weight loss. Depression is a difficult problem to treat but there are options and there is hope. Warm Regards, Dr. Darido

A formal work up is needed in this case and a barium swallow is not enough. An upper endoscopy to check for inflammation, ulceration and possible stricture of the distal esophagus and gastric pouch outlet is a must. Examined the length of the Roux limb must be performed using CT scan or other diagnostic modalities as a short Roux limb is the main cause of reflux in the setting of gastric bypass. A hiatal hernia repair by itself for a gastric bypass case offers minimal benefit in terms of reflux control if there is reflux. Warm regards, Dr Darido

Both procedures are great weight loss solutions. Gastric bypass is slightly more effective but a bit more invasive with potential longterm complications like marginal ulcers and internal hernias. The gastric sleeve if properly performed, and I insist on properly performed, can lead to great weight loss results with minimal side effects. Good luck, Dr Darido

An asymptomatic hiatal hernia after gastric bypass needs no repair. Most hiatal hernia after gastric bypass surgery are asymptomatic. You are right, the stomach can no longer be wrapped around the esophagus after gastric bypass. if you are suffering from acid reflux after gastric bypass surgery you may have a short Roux limb causing it rather than a hiatal hernia. Warm Regards, Dr Darido.