Practical Surgery Mushkies

Question 1

Nissen Fundoplication aim?

Answer 1

Prevent reflux and repair diaphragm

Question 2

Nissen Fundoplications procedure?

Answer 2

1. Usually lap
2. Wrap gastric fundus around lower oesophagus
3. Close any diaphragmatic hiatus

Question 3

Complications of Nissen Fundoplication?

Answer 3

1. Gas-bloat syndrome = inability to belch/vomit

2. Dysphagia if wrapped too tight

Question 4

Types of gastrectomy?

Answer 4

1. Antrectomy
2. Total Gastrectomy
3. Subtotal Gastrectomy

Question 5

Antrectomy types?

Answer 5

1. Bilroth I = simple anastomosis

2. Bilroth II = duodenal stump oversown + gastrojejunostomy

Question 6

Complications of gastrectomy?

Answer 6

1. Physical

2. Metabolic

Question 7

Physical complications of gastrectomy?

Answer 7

1. Increased risk of gastric cancer
2. Reflux or bilious vomiting
3. Abdominal fullness
4. Stricture
5. Stump leakage

Question 8

Metabolic complications of gastrectomy?

Answer 8

1. Dumping syndrome
2. Blind loop syndrome
3. Vitamin deficiency = B12, osetoporosis, bypassing proximal SB –> Fe and folate deficiency
4. Weight loss = malabsorption

Question 9

Blind loop syndrome?

Answer 9

Overgrowth of bacteria in duodenal stump, leading to malabsorption and diarrhoea

Question 10

Dumping syndrome?

Answer 10

Collection of signs and symptoms that occurs post gastrectomy when sugar moves too quickly into the duodenum, characterised by 2 phases:

1. Early DS (10-30mins after meal) = osmotic hypovolaemia
2. Late DS (2-3 hours after meal) = reactive hypoglycaemia

Question 11

S&S of dumping syndrome?

Answer 11

Abdo distension, flushing, N&V, fainting, sweating

Question 12

Ivor-Lewis Oesophagectomy?

Answer 12

2-stage surgical procedure for removing tumours of the distal 2/3rds of the oesophagus
1st = abdominal rooftop incision
2nd = right thoracotomy

Question 13

Whipple’s procedure?

Answer 13

Pancreaticoduodenectomy performed for removing tumours of the head of the pancreas, including removal of:

1. Gastric antrum
2. Gallbladder
3. Head of pancreas
4. Proximal duodenum
5. Regional lymph nodes

Question 14

EVAR complications?

Answer 14

1. MI
2. Spinal or mesenteric ischaemia
3. Renal failure
4. Graft migration or stenosis
5. Endoleaks

Question 15

What are endoleaks?

Answer 15

Persistent blood flow within the aneurysm sac following EVAR

Question 16

EVAR advantages?

Answer 16

1. Reduced perioperative mortality
2. Less stress in high risk pts
3. Reduced hospital stay
4. Improved cosmesis

Question 17

EVAR disadvantages?

Answer 17

1. No data on long term outcomes
2. Cant be used on all aneurysms
3. Lifelong monitoring with CT for endoleaks
4. More expensive
5. Doubtful long term advantage in terms of all cause mortality

Question 18

Carotid endarterectomy complications?

Answer 18

1. 7% risk of stroke/death w/in 30d
2. Haemorrhage –> haematoma
3. MI
4. Hypoglossal nerve damage = rare

Question 19

Indications for bypass grafting?

Answer 19

1. Very short claudication distance
2. Symptoms affecting pts QoL
3. Development of rest pain

Question 20

Practicalities of bypass grafting?

Answer 20

1. Need good proximal supply and sital run off
2. More distal grafts have increased rates of thrombosis
3. Saphenous vein grafts have increased rates of thrombosis
4. Prosthetic grafts may be employed

Question 21

Bypass grafting procedures?

Answer 21

1. Aorta/double iliac occlusion = aorto-bifem/axillo-fem
2. Single iliac = aorto-fem/fem-fem crossover/axillo-fem
3. SFA/PF = Fem-pop/fem-distal

Question 22

Complications of bypass grafting?

Answer 22

1. Haematoma
2. Distal embolism
3. Thrombosis

Question 23

TURP indications?

Answer 23

Surgical rx of choice for BPH when medical Rx has failed

Question 24

Principals of TURP?

Answer 24

1. Performed under spinal anesthetic
2. Cytoscopic inspection
3. Locate external urethral sphincter and use as distal resection landmark
4. Electrosurgical resection of prostatic tissue under direct vision
5. Send chippings for histology
6. Insert 3 way catheter post-op to irrigate bladder

Question 25

Complications of TURP?

Answer 25

1. Immediate 2. Early 3. Late

Question 26

Immediate complications of TURP?

Answer 26

1. TURP syndrome = absorption of large quantity of fluids -> reduced Na 2. Haemorrhage

Question 27

Early complications of TURP?

Answer 27

1. Haemorrhage 2. Infection 3. Clot retention = requires bladder irrigation

Question 28

Late complications of TURP?

Answer 28

1. Retrograde ejaculation = common 2. ED = 10% 3. Incontinence = <10% 4. Urethral stricture = LUTS post TURP 5. Recurrence

Question 29

Dohlman's procedure?

Answer 29

Pharyngeal pouch = minimally invasive endoscopic stapling

Question 30

Heller's cardiomyotomy?

Answer 30

Achalasia = longitudinal incision through muscularis propria at LOS

Question 31

Ramstedt's pyloromyotomy?

Answer 31

Pyloric stenosis = longitudinal incision through muscularis propria at the pylorus

Question 32

Ivor-Lewis?

Answer 32

Oesophageal cancer = 2-stage oesophagectomy

Question 33

Anal fissure surgery?

Answer 33

Lateral sphincterotomy = division of internal anal sphincter @ 3 o clock

Question 34

Delorme's procedure?

Answer 34

Rectal prolapse = perineal approach with mucosal resection

Question 35

Trendelenberg operation?

Answer 35

Varicosities = SFJ ligation

Question 36

Cockett's operation?

Answer 36

Varicosities = perforator ligation

Question 37

Trahere transplantation?

Answer 37

Chronic venous insufficiency = transplant of axillary vein with valve into the deep venous leg veins

Question 38

Kistner operation?

Answer 38

Chronic venous insufficiency = venous valvuloplasty

Question 39

Palma operation?

Answer 39

Chronic venous insufficiency = bypass venous obstruction with contralateral GSV

Question 40

Palomo operation?

Answer 40

1. Varicocoele = high retroperitoneal approach for ligation of testicular veins 2. Transverse incision at level of the ASIS centred on the mid-inguinal point

Question 41

Lord's repair?

Answer 41

Hydrocele = plication of the tunica vaginalis

Question 42

Jaboulay's repair?

Answer 42

Hydrocele = eversion of the tunica vaginalis

Question 43

Dartos Pouch Procedure?

Answer 43

Undescended testis = mobilisation of testis and placement in a s/c pouch via a hole in the dartos muscle (dartos prevents retraction)

Question 44

Sistrunk's operation?

Answer 44

Thyroglossal cyst = excision of cyst and thyroglossal duct