AIIMS GI 2023

Blunt colon injury

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Q) 45 year old male with 24 hour  old blunt colon injury is explored and found to have limited spillage of contents. There is no other intra abdominal injury. Haemodynamically stable.  He has received three units of blood transfusion. Ideal management at surgery would be ?

a) Resection and Anastomosis

b) Resection anastomosis with loop ileostomy

c) Resection and Hartmanns

d) Ileostomy

INI GI Surgery

Sabiston page 422

THE vs TTE

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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

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