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

Hereditary pancreatic cancers

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Hereditary pancreatic cancers questions is asked many times in NEET SS and GI and onco Surgery CET 

Please understand the difference between x% lifetime risk of pancreatic cancer and x fold increase in risk as compared to normal population

  1. PRSS & SPINK 1 - Familial pancreatitis 40% lifetime increase . 50 fold increase as compared to Normal
  2. STK 11 - Peutz Jeghers - 100 fold increase in Pancreatic cancer . Also associated with lung, ovarian, breast, uterine, and testicular cancers
  3.  CFTR - cystic fibrosis - 30 fold increase
  4. Familial atypical mole and multiple melanoma syndrome (CDKN2A gene mutation). CDKN2A - 20 fold increase
  5.  BRCA 2 - 10 fold increase
  6. Lynch Syndrome  ( MLH) ( MSH) - 8 fold increase
  7. FAP APC gene - 4 fold

Bile leak after lap Cholecystectomy

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Q) 60 year old female undergoes lap cholecystectomy and is discharged She comes back 8 days later with pain abdomen, distension, fever and tachycardia. USG shows a 500 ml collection in Morrisons Pouch. Next step?

a) Conservative, I V antibiotics

b) USG guided drainage

c) LAP exploration and ligation of cystic duct stump

d) CECT followed by open exploration

#NEET SS 22

# Questions on BIliary system

# Free Questions on Bile ducts

Ulcerative colitis Surgery in Young female

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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)

#AIIMS 2022 April 

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.

Pyoderma Gangrenosum

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Q) Which of the following systemic disease is not associated with Pyoderma Gangrenosum ?

a) Rheumatoid arthritis

b) Inflammatory bowel disease

c) Non Hodgkin disease

d) Sjogern syndrome

Pancreas transplant

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Q) Most common indication for pancreas transplant

a) Type II DM 

b) Type II DM with nephropathy

c) Type I DM

d) Type I DM with nephropathy

d) Type I DM with nephropathy

Pancreas transplantation is typically performed for individuals with Type 1 diabetes who also have end-stage renal disease, often requiring kidney dialysis. This combination of kidney failure and Type 1 diabetes makes pancreas transplantation a viable treatment option.

SPK is the most frequently performed procedure for patients with type 1 diabetes and renal failure due to diabetic nephropathy.

There is a small population of patients with type 1 diabetes with renal failure due to primary renal disease or non-diabetic causes and they are also included in this group.

 

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