Abdomen

THE vs TTE

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Esophagus Surgery
Esophagus Mock Test 1
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
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Ulcerative colitis Surgery in Young female

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Ulcerative Colitis Surgery Choice
#AIIMS 2022 April
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)
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.
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Hereditary Risk of Ca Stomach

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Hereditary Risk Factors for Gastric Cancer MCQ | mcqsurgery.com
Q) Which of the following is a hereditary risk factor associated with carcinoma of the stomach?
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This answer is available for premium users.

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Free Questions Mock Tests

Chylous Ascites

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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

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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

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📘 Theme: Rectal Prolapse

True about the Altemeier procedure?

A. It is proctosigmoidectomy with posterior levatoroplasty
B. Done in left lateral position
C. Recurrence rate can be as high as 50%
D. Altemeier was the first person to do it

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✅ Answer: A. It is proctosigmoidectomy with posterior levatoroplasty

Explanation:
The Altemeier procedure is a perineal rectosigmoidectomy (proctosigmoidectomy) performed for complete rectal prolapse. It is commonly combined with posterior levatoroplasty, which restores pelvic floor support and helps reduce recurrence.

Why the other options are incorrect:

  • B. The procedure is usually performed in the lithotomy position, not the left lateral position.
  • C. Reported recurrence rates are generally 10–30%; a recurrence rate of 50% is not considered typical.
  • D. Although the procedure bears Altemeier's name, he popularized and refined the operation rather than being the first to perform it.

Take-home Message:
Altemeier = Perineal rectosigmoidectomy + posterior levatoroplasty; performed in the lithotomy position; preferred perineal operation for complete rectal prolapse in elderly or high-risk patients.

Reference: Sabiston Textbook of Surgery, 22nd Edition, p. 1394.

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