Upper GI Surgery

Question 1

In what sex is oesophageal cancer more common and what is its 5 year survival rate?

Answer 1

Males

10%

Question 2

What are the signs and symptoms of oesophageal cancer?

Answer 2

Weight loss & Anorexia
Progressive dysphagia
Odynophagia
Chest pain/heart burn
Haematemesis

Question 3

What is used to tell the difference between a benign and malignant tumour?

Answer 3

Endoscopy

Question 4

What should be done if patient is malignant/unfit?

Answer 4

Offer palliative care - Chemo/Radiotherapy

Stenting if Dysphagia

Question 5

What is an oesophagectomy?

Answer 5

Oesophagus is removed and the conduit is made from the colon or stomach

Question 6

If patient undergoes an oesophagectomy what must happen?

Answer 6

They must be infused with nutrition as they have no stomach

Question 7

What can be offered if patient is worried about resection but has no metastatic spread?

Answer 7

Chemotherapy & Radiotherapy

Question 8

What is gastric cancer associated with and what sex is it more common in?

Answer 8

H. pylori and almost always adenocarcinomas

Males

Question 9

What is the presentation of gastric cancer?

Answer 9

Non-specific

Question 10

What alarming features appear with dyspepsia in gastric cancer presentation?

Answer 10

Dysphagia
Upper abdominal mass
Evidence of GI blood loss
Weight loss
Vomiting

Question 11

What three types of surgery can be undergone for gastric cancer?

Answer 11

Subtotal gastrectomy
Total gastrectomy
Roux en Y construction - Whole stomach is removed

Question 12

When is anti-reflux surgery done?

Answer 12

For GORD

Question 13

What are the symptoms of GORD?

Answer 13

Heartburn
Waterbrash
Cough

Question 14

What are the risk factors for GORD?

Answer 14

Obesity
Smoking
Alcohol excess

Question 15

How can GORD be managed?

Answer 15

Lifestyle modification & PPI therapy or surgery

Question 16

How can GORD result from a sliding hiatus hernia?

Answer 16

Junction doesn’t work as well above the hernia

Question 17

What are the side effects of laparoscopic hiatus hernia repair and fundoplication?

Answer 17

Dysphagia
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea

Question 18

What is bariatric surgery?

Answer 18

Reducing the size of the stomach to help weight loss as obesity leads to a lower life expectancy and a higher risk of death

Question 19

What are the three types of bariatric surgery?

Answer 19

Restrictive
Malabsorptive - Bypass segments of bowel to cause malabsoprtion of nutrients
Combination - Involves malabsorption and restrictive

Question 20

What are the advantages of Laparoscopic Adjustable Gastric Banding?

Answer 20

Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Mortality 0.1%

Question 21

What are the disadvantages of Laparoscopic Adjustable Gastric Banding?

Answer 21

Requires an implanted medical device
Easier to “cheat”
Risk of prolapse or slippage
15% will require revisional surgery

Question 22

What happens in Laparoscopic Adjustable Gastric Banding?

Answer 22

Hollow silicon band is placed around the stomach near its upper end
Band inflated with isotonic fluids so it can be tightened or loosed over time to change the size of the passage by increasing or decreased the amount of fluid

Question 23

What is a Laparoscopic Gastric Bypass?

Answer 23

A small stomach pouch is created to restrict food intake with a Y-section of the small intestine being attached to the pouch to allow food to bypass the lower stomach, duodenum and first portion of the jejunum
This reduces nutrient absorption

Question 24

What are the advantages to a Laparoscopic Gastric Bypass?

Answer 24

Quick and dramatic weight loss
Pedigree
Dumping syndrome

Question 25

What are the disadvantages to a Laparoscopic Gastric Bypass?

Answer 25

More invasive surgery
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%

Question 26

What is a Laparoscopic Sleeve Gastrectomy?

Answer 26

Partial gastrectomy that results in removal of most of the stomach and the shape of the smaller stomach resembles a half-moon

Question 27

What are the advantages of a Laparoscopic Sleeve Gastrectomy?

Answer 27

Good medium term outcomes
No “dumping syndrome”
No small bowel manipulation
No foreign body

Question 28

What are the disadvantages of a Laparoscopic Sleeve Gastrectomy?

Answer 28

More invasive surgery
Long staple line
Short pedigree
Mortality 0.4%

Question 29

What are the complicatios of Laparoscopic Sleeve Gastrectomy?

Answer 29

DVT/PE
Infection
Malnutrition
Hair loss
Excess skin