Upper GI surgery

Question 1

What are the treatment options of oesophageal cancer that has been staged as metastatic/ unfit?

Answer 1

• Stenting
• Palliative radiotherapy
• Palliative chemotherapy

Question 2

What are the treatment options of oesophageal cancer that has been stages resectable/ fit?

Answer 2

• Oesophagectomy + Chemotherapy
• 5 year survival approx 30%
• Concerns about resection/fitness and no metastatic disease
• Chemo/Radiotherapy
• 5 year survival approx 20%

Question 3

Describe an esophagectomy (giving all of the background information as well)

Answer 3

Approach
- Ivor Lewis
- Trans-hiatal
- Left thoracoabdominal
Conduit
- Stomach
- Colon
Morbidity 20-30%
Mortality 5-10%
Return to pre-op QOL 10 months

Question 4

What surgerys can be done for gastric cancer?

Answer 4

• Subtotal gastrectomy
• Total gastrectomy and route en Y reconstruction
• Laparoscopic distal gastrectomy
• Open gastrectomy

Question 5

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

Answer 5

• Dysphagia
• Difficulty to belch and vomit
• Gas Bloating
• Excess flatulence
• Diarrhoea

Question 6

What are the advantages of laparoscopic adjustable banding?

Answer 6

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

Question 7

What are the disadvantages of laparoscopic adjustable banding?

Answer 7

• Requires an implanted medical device
• Easier to ‘cheat’
• Risk of prolapse or slippage
• 15% will require revisional surgery

Question 8

What are the advantages of laparoscopic sleeve gastrectomy?

Answer 8

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

Question 9

What are the disadvantages of laparoscopic sleeve gastrectomy?

Answer 9

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

Question 10

What are the advantages of a laparoscopic gastric bypass?

Answer 10

• Quick and dramatic weight loss
• Pedigree
• Dumping syndrome

Question 11

What are the disadvantages of a laparoscopic gastric bypass?

Answer 11

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

Question 12

What are the complications of bariatric surgery?

Answer 12

• Anastomotic leak
• DVT/PE
• Infection
• Malnutrition
• Vitamin and mineral deficiencies
• Hair loss
• Excess Skin