Gall bladder

Carcinoma GB epidemiology

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Q) Not true about GB malignancy

A. 80 percent of porcelain gall bladder predispose to malignancy

B. Untreated advanced  CA GB  median survival is 2-5 months

C. Stippled calcification of mucosa has higher risk of malignancy than diffuse intramural calcification

D. More than 75 percent of CA gall bladder has history of cholelithiasis

 

Intra op cholangio

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Q) All of the following are indications for performing intra op cholangiography except:

A. Pain around the day of surgery
B. Anomalous biliary anatomy
C. Suspicious findings on ERCP
D. Abnormal hepatic function panel

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Risk factors for Ca gall bladder

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Q) Risk factor for CA GB are all except
A. Multiple polyp
B large gall stone >3 cm
C PSC
D pigment stone same risk as cholesterol stone

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Radical Cholecystectomy

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 Q) Radical cholecystectomy includes all except

a) Segment IVb and Va

b) 2cm wedge resection

c) Rt Extended Hepatectomy

d) Paraaortic lymphnodes

Answer and Explanation here

History of Radical Cholecystectomy

  1. Early 20th century removal of gall bladder and wedge of liver ( No lymphadenectomy) 
  2. In 1954, Glenn et al - radical resection procedure with intended regional lymphadenectomy (portal lymph node dissection), designated as “radical cholecystectomy” (Glenn operation)
  3.  Fahim et al in 1962 advocated radical resection consisting of hepatectomy and portal lymph node dissection

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NOTES

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Q) Regarding minimal access cholecystectomy all are true except?

a) NOTES can be done transvaginally and transgastrically

b) Transgastric route is preferred

c) SILS is done through single port with multiple instruments avoiding multiple ports

d) SILS has difficulty with triangulation and retraction

Answer is B

Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy. 

The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application. 

This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue.

Shackelford

Post cholecystectomy injury

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Q   Post cholecystectomy Injury, which is true?

a.       Bile duct leak in approx 1%

b.      Open cholecystectomy bile duct injury 0.5 to 1 %

c.       Most common cause of bile leak is cystic stump blowout and duct of lushka injury

d.      Type E injury is due to clipping of CBD by mistake

 

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