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
Free Questions
Free MCQs in Surgery
Esophageal hiatus hernia
What is a Type III esophageal (hiatal) hernia?
Correct Answer
c) Combination of sliding and paraesophageal herniaExplanation
Hiatal hernias are classified based on the position of the gastroesophageal junction and stomach. Type I involves upward displacement of the GEJ into the thorax. Type II has a normally positioned GEJ with part of the stomach herniating alongside the esophagus. Type III is a mixed hernia where both the GEJ and stomach herniate into the thoracic cavity. Option (d) is more consistent with a giant paraesophageal hernia (Type IV).Teaching Points
- Type I is the most common and associated with GERD
- Type III is a mixed hernia involving GEJ and stomach
- Type II and III have higher risk of volvulus and strangulation
- Large hernias with most of the stomach in chest are Type IV
Hemangioma Liver
A 38-year-old woman is found to have a 12-cm hepatic hemangioma. Which statement regarding management is true?
Correct Answer
d) If surgery is planned, peripherally located hemangiomas should be enucleatedExplanation
Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally. Management depends on symptoms, complications, and diagnostic certainty, not size alone.
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Size and surgery:
Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic. -
Oral contraceptives and pregnancy:
Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended. -
Role of arterial embolization:
Arterial embolization is not performed routinely. It is reserved for:- Symptomatic patients unfit for surgery
- Acute bleeding
- Preoperative reduction of tumor vascularity
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Surgical technique:
When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:- Preserves maximum liver parenchyma
- Results in less blood loss
- Has lower morbidity compared to formal hepatic resection
Teaching Points
- Hepatic hemangioma is the most common benign liver tumor
- Size alone is not an indication for surgery
- Most asymptomatic hemangiomas require only observation
- Enucleation is preferred over resection when surgery is needed
- Embolization is reserved for selected symptomatic or high-risk cases
Complications of Billroth II surgery
Complications of Billroth II – Free MCQ (GI Surgery)
High-yield stomach surgery question for NEET SS & GI Surgery preparation. Use the Answer Free button to reveal the explanation.
Q) What is true regarding complications of Billroth II surgery?
Answer c -
In Billroth II surgery, afferent limb obstruction is more common
In Billroth I reconstruction The remnant is anastomosed to the duodenum
In Billroth II duodenum stump is closed and stomach is anastomosed to the jejunum limb
Advantages of Billroth I
- More Physiological as normal GI continuity is maintained
- No problem of afferent and efferent limb
- Future procedures like endoscopy and ERCP can be done
- Reduced chance of gastric carcinoma in remnant stomach as compared to Billroth 2 ( SKF page 682)
In surgery for benign gastric ulcers, Billroth I reconstruction is the preferred choice.
Billroth II surgery has problems of
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%
Billroth 2 surgery is done when there is
1. Inadequate mobility of the duodenum
2. Scarring of duodenum
Complications of gastric surgery
Complications of gastrectomy
- Nutritional and weight loss - Iron deficiency, Copper deficiency, Vit B12 , Anemia
- Delayed gastric emptying
- Roux statsis- Seen in roux en y loops- Pain, nausea, vomiting, abdominal bloating
- Cholelithiasis- Higher incidence in roux en y reconstruction as compared to B1 and B 2 gastrectomy
- Recurrent ulceration
Complications of Billroth 2 surgery
- Dumping syndrome Dumping symptoms have been reported in up to 70% of Billroth II patients and up to 75% of patients after RYGBP for obesity.
- Afferent loop obstruction - It can be minimized by keeping the length of afferent loop less than 20 cm and using a retrocloic approach.
- Bile reflux gastritis - More common with billroth I and billroth 2 surgery, incidence is decreasing after the use roux en y anastomosis
Hirchsprung’s disease
Which of the following is a FALSE statement regarding Hirschsprung’s disease?
Correct Answer
a) Male and female have equal incidenceExplanation
Hirschsprung’s disease is a congenital disorder characterized by absence of ganglion cells in the distal bowel, leading to functional intestinal obstruction.
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Sex distribution:
Hirschsprung’s disease shows a clear male predominance. The male-to-female ratio is approximately 4:1 in short-segment disease. Therefore, equal incidence in males and females is false. -
Extent of disease:
Total colonic aganglionosis occurs in about 5–10% of patients, making option (b) true. -
Postoperative outcome:
Following pull-through surgery, bowel dysfunction is common. Constipation is the most frequent long-term problem, so option (c) is true. -
Genetic associations:
Hirschsprung’s disease is associated with chromosomal anomalies. Down syndrome is seen in approximately 2–10% of cases, making option (d) true.
Teaching Points
- Hirschsprung’s disease has a strong male predominance
- Total colonic aganglionosis occurs in about 5–10% of cases
- Constipation is the most common long-term complication after surgery
- Down syndrome is the most common genetic association
- Enterocolitis is the most feared complication, especially in infants
HCC Cancer
Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)
a) Alpha feto protein should be done 6 monthly
b) Ultrasound abdomen should be done 6 monthly
c) Candidates for liver transplant should be screened every 3 months
d) Nodules more than 2 cm should be followed up more regularly
Recurrent Pyogenic Cholangitis (RPC)
Q) Which statement is not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
Beger Procedure for Chronic Pancreatitis
Q: True about Beger procedure for chronic pancreatitis
# Theme NEET SS Pancreas MCQ
a) Posterior branch of gastro duodenal artery is preserved.
b) Beger procedure is a pancreatic head mass resection that can be done for small pancreatic tumors.
c) Intra pancreatic, choledochal and ampullary structures are removed.
d) Neck of the pancreas is not transected
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