Upper GI Surgery Flashcards
In what sex is oesophageal cancer more common and what is its 5 year survival rate?
Males
10%
What are the signs and symptoms of oesophageal cancer?
Weight loss & Anorexia Progressive dysphagia Odynophagia Chest pain/heart burn Haematemesis
What is used to tell the difference between a benign and malignant tumour?
Endoscopy
What should be done if patient is malignant/unfit?
Offer palliative care - Chemo/Radiotherapy
Stenting if Dysphagia
What is an oesophagectomy?
Oesophagus is removed and the conduit is made from the colon or stomach
If patient undergoes an oesophagectomy what must happen?
They must be infused with nutrition as they have no stomach
What can be offered if patient is worried about resection but has no metastatic spread?
Chemotherapy & Radiotherapy
What is gastric cancer associated with and what sex is it more common in?
H. pylori and almost always adenocarcinomas
Males
What is the presentation of gastric cancer?
Non-specific
What alarming features appear with dyspepsia in gastric cancer presentation?
Dysphagia Upper abdominal mass Evidence of GI blood loss Weight loss Vomiting
What three types of surgery can be undergone for gastric cancer?
Subtotal gastrectomy
Total gastrectomy
Roux en Y construction - Whole stomach is removed
When is anti-reflux surgery done?
For GORD
What are the symptoms of GORD?
Heartburn
Waterbrash
Cough
What are the risk factors for GORD?
Obesity
Smoking
Alcohol excess
How can GORD be managed?
Lifestyle modification & PPI therapy or surgery
How can GORD result from a sliding hiatus hernia?
Junction doesn’t work as well above the hernia
What are the side effects of laparoscopic hiatus hernia repair and fundoplication?
Dysphagia Difficulty to belch and vomit Gas bloating Excess flatulence Diarrhoea
What is bariatric surgery?
Reducing the size of the stomach to help weight loss as obesity leads to a lower life expectancy and a higher risk of death
What are the three types of bariatric surgery?
Restrictive
Malabsorptive - Bypass segments of bowel to cause malabsoprtion of nutrients
Combination - Involves malabsorption and restrictive
What are the advantages of Laparoscopic Adjustable Gastric Banding?
Relatively minor surgery
Reversible and adjustable
Low operative complication rate
Mortality 0.1%
What are the disadvantages of Laparoscopic Adjustable Gastric Banding?
Requires an implanted medical device
Easier to “cheat”
Risk of prolapse or slippage
15% will require revisional surgery
What happens in Laparoscopic Adjustable Gastric Banding?
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
What is a Laparoscopic Gastric Bypass?
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
What are the advantages to a Laparoscopic Gastric Bypass?
Quick and dramatic weight loss
Pedigree
Dumping syndrome
What are the disadvantages to a Laparoscopic Gastric Bypass?
More invasive surgery
Malabsorptive component requires lifelong supplements
More complex if requires revision
Mortality 0.5%
What is a Laparoscopic Sleeve Gastrectomy?
Partial gastrectomy that results in removal of most of the stomach and the shape of the smaller stomach resembles a half-moon
What are the advantages of a Laparoscopic Sleeve Gastrectomy?
Good medium term outcomes
No “dumping syndrome”
No small bowel manipulation
No foreign body
What are the disadvantages of a Laparoscopic Sleeve Gastrectomy?
More invasive surgery
Long staple line
Short pedigree
Mortality 0.4%
What are the complicatios of Laparoscopic Sleeve Gastrectomy?
DVT/PE Infection Malnutrition Hair loss Excess skin
