Upper GI Surgery

Question 1

how does oesophageal cancer present?

Answer 1

> progressive dysphagia
> anorexia
> odynophagia
> chest pain
> haematemesis

Question 2

what are the treatment options for unfit patients with oesophageal cancer?

Answer 2

> stenting
palliative radiotherapy
palliative chemotherapy

Question 3

what are the treatment options for fit patients with oesophageal cancer?

Answer 3

> oesophagectomy + chemotherapy

Question 4

name three approaches to oesophagectomy

Answer 4

> ivor lewis
trans-hiatal
left thoraco-abdominal

Question 5

what can be used as a conduit in an oesophagectomy?

Answer 5

> stomach

> colon

Question 6

in what way will the patient have to adapt after an oesophagectomy?

Answer 6

they will have to eat small meals often, avoid eating before bed and may have to sit up to sleep

Question 7

what surgeries can you perform in gastric cancer?

Answer 7

> subtotal gastrectomy
total gastrectomy and roux en y reconstruction
these can be open or laparoscopic

Question 8

what side effects can there be from a laparoscopic hiatus hernia repair and fundoplication?

Answer 8

> dysphagia
> difficulty to belch or vomit
> gas bloating
> excess flatulence
> diarrhoea

Question 9

what obesity classification must you be to be considered for obesity surgery?

Answer 9

obesity 2: 35.0-39.9

obesity 3: >40

Question 10

what types of bariatric surgery are there?

Answer 10

> restrictive
malabsorption
combination

Question 11

what are the advantages of laparoscopic adjustable gastric banding?

Answer 11

> relative minor surgery
reversible and adjustable
low complication rate
0.1% mortality

Question 12

what are the disadvantages of laparoscopic adjustable gastric banding?

Answer 12

> requires implanted medical device
easy to cheat
risk of prolapse or slipping
15% will require revisional surgery

Question 13

what are the advantages of a laparoscopic gastric bypass?

Answer 13

> Quick and dramatic weight loss
Pedigree
Dumping syndrome

Question 14

what are the disadvantages of a laparoscopic gastric bypass?

Answer 14

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

Question 15

what are the advantages of a laparoscopic sleeve gastrectomy?

Answer 15

> Good medium term outcomes
No ‘dumping’ syndrome
No small bowel manipulation
No foreign body

Question 16

what are the disadvantages of a laparoscopic sleeve gastrectomy?

Answer 16

> More invasive surgery
Long staple line (bleeding/leak)
> Short pedigree
Mortality 0.4%

Question 17

what complications can arise from bariatric surgery?

Answer 17

> anastomotic leak
> DVT/PE
> infection
> malnutrition
> vitamin and mineral deficiencies
> hair loss
> excess skin