Questions on Surgery of esophagus asked in MCH GI surgery Exams
Mcqsurgery.com The place for doctors to try competitive surgery Questions . Topic Surgery of Esophagus
Q1. The usual incision given for surgery of Zenker's diverticulum of esophagus is
a) Left Cervical incision
b) Right Cervical
Q2. In Transhiatal Vs Trans thoracic esophagectomy most common complication associated with THE (Trans Hiatal esophagectomy) is
a) Pulmonary complications
b) Anastomotic leak
d) Injury to recurrent laryngeal nerve
Q3.Which is the most disabling complication after three field esophagectomy?
b) Recurrent laryngeal nerve palsy
c) Tracheal stenosis
Q4. What is the most common complication after esophagectomy
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
All references are from
The pharyngoesophageal diverticulum (Zenkerís diverticulum) (ZD) is the most common esophageal diverticulum. It is a blow out of the mucosa of esophagus through a defect in the posterior wall of esophagus between hypopharynx and esophagus. (Killian's triangle)
3.Incordination between hypophraynx and sphincter to relax
Other mechanisms proposed are
1. Fibrosis of cricopharyngeal muscle
2. Spasm of Cricophayngeus due to abonormal reflux (GERD)
There is loss of ATPase and energy changes in patients with ZD.
Both neurogenic and myogenic abnormalities are present.
At this stage, poor UES compliance rather than cricopharyngeal incoordination appears to be the most plausible explanation
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.
Salivary fistula 3-25%
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
Now Orringer the proponent of Transhiatal esophagectomy has published that the use of stapled side to side esophagogastric anastomoses in THE has reduced the anatomotic leak rate to 3%
This means now recurrent laryngeal nerve injury is more in THE group than TTE group
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
Pulmonary complications occurred in 32.8%, cardiac dysrhythmias in 10.9%, and persistent recurrent nerve problems in 2.6%.
Questions on Esophagus and Esophageal surgery. This site is for medical students to help them prepare for various entrance examinations. This page deals with questions and answers on esophagus and related pathologies. Answers are provided at the end of 5 questions with references from surgery books. Specific topicwise questions can be found using the links above. For details see here .The website will always be free and we will never ask you to be a member or login.
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