THE vs TTE

Q) Trans Hiatal Esophagectomy ( THE)  vs Trans Thoracic Esophagectomy ( TTE)   which is not true? ( Question asked in all AIIMS and INI exams since 2017) 

a) Leak rates are more with TTE 

b) Pulmonary complication is more with TTE

c) Side to side stapler anastomosis has less leaks than open two layer suturing

d) THE can be done through minimally invasive surgery

Esophagus Mock test  1

Esophagus Mock test 2 

Ans c

Pulmonary complications  are 57% with TTE 27% with  THE  ( SKF 409)

Anastomotic leak 16% TTE and 14% THE ( not significant) subclinical leak slightly more in THE

Option D is correct

Cardiac complications, Vocal cord paralysis , wound infection, chyle leak are all more with TTE

Blackmon et al. published a propensity-matched analysis comparing outcomes between side-to-side stapled anastomosis, end-to-end circular stapled anastomosis, and handsewn,
with no significant difference in leak rate noted.  ( SKF page 475)

SKF page 409

Ulcerative colitis Surgery in Young female

Q) Which surgery would be preferred to be done in young unmarried  female with steroid refractory Ulcerative colitis  and 15 bloody bowel movements per day? 

a) TPC with IPAA

b) TPC with EI ( end ileostomy) 

c) TAC with EI ( end ileostomy) 

d) TAC with IRA ( Ileo rectal anastomosis) 

#AIIMS 2022 April 

Colon

Ans b

The risk of infertility following IPAA was estimated to be approximately 50% compared with 15% among medically treated patients.
Given these data, many surgeons advocate for a three-stage procedure in which subtotal colectomy with end ileostomy is performed and IPAA is deferred until childbearing is
completed.
SKF 8th page 1936

Chylous Ascites

Q) Which of the following is least likey mechanism of formation of chylous ascites

a) Obstruction of existing lymphatics with exudation of chyle

b) Chyle leak from lymph vessels due to injured retroperitoneal vessels

c) Mega lymphatics exudation which are present in the wall of retroperitoneum

d) Recurrent chronic pancreatitis

Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Ans b 

Get a contrast CT Abdomen as bowel ischemia is a likely diagnosis 

Incidence of bowel ischemia after repair of aortic aneurysm is around 2-6%. It is because of loss of inferior mesenteric artery artery at the time of surgery and inadequate colonic collaterals. 

Spores and clostridium difficle diarrhea occurs after prolonged antibiotic use. Also there is no bloody diarrhea in it.

Exploratory laparotomy will be required after CT Shows full thickness gangrene and not before

Antibiotic escalation will not help at this stage.

 

Altemeier procedure

Q) True about altemeier procedure?

a) It is proctosigmoidectomy with posterior levataroplasty

b) Done in left lateral position

c) Recurrence rate can be as high as 50%

d) Altemeier was the 1st person to do it

Ans a

The Altemeier procedure, also known as perineal rectosigmoidectomy, is a surgical technique used to treat rectal prolapse.

Altemeier procedure is a perineal surgical procedure in moribund and old patients.

It combines proctosigmoidectomy with posterior  levatorplasty.

A disadvantage of the perineal proctosigmoidectomy is the increased recurrence rates of
12% to 24% compared with the abdominal approach.

It is done in prone jack- knife position It was initiated by Mikulicz in 1899 and popularized by Altemeier in 1920s