Q3.Which is the most disabling complication after three field esophagectomy?
a) Bronchorrhoea
b) Recurrent laryngeal nerve palsy
c) Tracheal stenosis
d)
Q4. What is the most common complication after esophagectomy
a) Arrythmia
b) Pulmonary Collapse and Consolidation
c) Recurrent laryngeal nerve injury
d) Massive bleeding
Q 5.Most valuable investigation for preoperative evaluation of extensive corrosive stricture is
a) Endoscopic ultrasound
b) Barium study
c) CT Thorax
d) Pharyngoscopy
Answers
1. a
The pharyngoesophageal diverticulum (Zenker’s diverticulum) is the most common esophageal diverticulum. Zenker’s diverticulum usually presents in patients older than 60 years.
Treatment can be done endoscopically or surgically. A commonly used surgical approach is cervical esophagomyotomy and resection of the diverticulum performed through an oblique left cervical incision that parallels the anterior border of the sternocleidomastoid muscle or a transverse cervical incision centered over the cricoid cartilage.
2. b
The transhiatal cervical anastomosis predisposes to a higher rate of leaks (13.6% for transhiatal vs. 7.2% for transthoracic)
Transthoracic resections, which involve a posterolateral thoracotomy, have a higher incidence of pulmonary complications compared with the transhiatal approach
A review of the literature with a meta-analysis,has shown that operative blood loss is significantly less during transhiatal esophagectomy compared with transthoracic esophagectomy
Sabiston surgery 17th edition
3. a
Three field esophagectomy involves lymph node dissection in the cervical, mediastinal and abdominal
region. In contrast to the standard two field esophagectomy, japanese surgeons argue that three field esophagectomy leads to better prognostication and survival benefits without significantly increasing the morbidity and mortality.
Cervical lymphadenectomy included the paratracheal lymph nodes (deep internal nodes). The nodes lateral from the sternocleidomastoid muscle, ie, lateral to the internal jugular vein and supraclavicular nodes
4.b
Pulmonary complications occurred in 32.8%, cardiac dysrhythmias in 10.9%, and persistent recurrent nerve problems in 2.6%.
5.a
