1st three questions are free to see and evaluate. All other topic wise questions with explanations will be seen by premium members
Esophagus
Q) Best management of Barrett with high grade dysplasia as per Seattle criteria is
a) RFA
b) Vagus sparing esophagectomy
c) Esophagectomy
d) Surveillance
Ans
a
HIGH-GRADE DYSPLASIA OR INTRAMUCOSAL ADENOCARCINOMA
Options to treat are
Endoscopic resection of visible lesions
Ablation of Barrett mucosa most frequently by RFA
Consider esophagectomy patients with ultra-long (8 cm or more Barrett) b) when multifocal disease present c) patients with difficult to control or severe GERD especially in the setting
of poor esophageal motility and large hiatal hernia
Shackelford page 341 Box 33.1
Q) THE vs 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
d) THE can be done through minimally invasive surgery
Ans c
Pulmonary complications 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
Q) After THE, there is a symptomatic collection in the left chest diagnosed on X ray. ICD is placed which drains 75-100 ml. However there is chest pain and collection persists, next step?
a) Continue conservative
b) Chest Physio and repeat x ray
c) Surgery
d) Exclude conduit necrosis and replace chest tube
Ans d
The management of intrathoracic leaks depends upon the degree of sepsis.
Patients with contained collections may be treated with percutaneous drainage.
Patients with hemodynamic stability in the setting of sepsis should be taken to the operating room for washout and drainage.
Conservative operative treatment, with débridement and refashioning of the anastomosis, has been described with 25% risk of recurrent leak
SKF page 476
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