Q1) A 70-year-old male presents with a diagnosis of Zenker's diverticulum and requires open surgery. The usual incision given for surgery of Zenker's diverticulum of esophagus is?
a) Left Cervical
b) Right Cervical
c) Suprahyoid
d) Midline
Answer: a) Left Cervical
Zenker's diverticulum is a pulsion (false) diverticulum between the cricopharyngeal and inferior constrictor muscles at Killian’s dehiscence.
Zenker’s diverticulum is the most common esophageal diverticulum It Occurs due to 1. Increased upper esophageal sphincter (UES) pressure 2. Failure of UES to relax 3.Incordination between hypophraynx and sphincter to relax Treatment can be done endoscopically or surgically. 🔸 Most common esophageal diverticulum
🔸 Caused by:
1. Increased UES pressure
2. Failure of UES to relax
3. Incoordination of hypopharynx with sphincter
🔸 Surgery is done via an **oblique left cervical incision**
🔸 Treatment options: Myotomy + diverticulum resection or endoscopic stapling
🔸 Complications: Salivary fistula (4–24%), recurrence (2.5–20%)
Zenker's diverticulum is a pulsion (false) diverticulum between the cricopharyngeal and inferior constrictor muscles at Killian’s dehiscence.
Zenker’s diverticulum is the most common esophageal diverticulum It Occurs due to 1. Increased upper esophageal sphincter (UES) pressure 2. Failure of UES to relax 3.Incordination between hypophraynx and sphincter to relax Treatment can be done endoscopically or surgically. 🔸 Most common esophageal diverticulum
🔸 Caused by:
1. Increased UES pressure
2. Failure of UES to relax
3. Incoordination of hypopharynx with sphincter
🔸 Surgery is done via an **oblique left cervical incision**
🔸 Treatment options: Myotomy + diverticulum resection or endoscopic stapling
🔸 Complications: Salivary fistula (4–24%), recurrence (2.5–20%)
Q2) In Transhiatal vs Transthoracic esophagectomy, the most common complication associated with Transhiatal Esophagectomy (THE) is:
a) Pulmonary complications
b) Anastomotic leak
c) Bleeding
d) Injury to recurrent laryngeal nerve
Answer: d) Injury to recurrent laryngeal nerve
🔹 In Transhiatal Esophagectomy (THE), dissection through the neck and mediastinum is done without opening the chest, increasing the risk of **recurrent laryngeal nerve injury**.
🔸 Leak rate: 7.6% in THE vs 9.4% in TTE
🔸 Pneumonia: 13.8% (THE) vs 16.8% (TTE)
🔸 Bleeding: Less in THE
🔸 Cervical anastomosis in THE (Orringer’s stapled method) reduces leak to 3%
🟢 THE avoids thoracotomy but carries higher risk of nerve injury due to blind dissection.
🔹 In Transhiatal Esophagectomy (THE), dissection through the neck and mediastinum is done without opening the chest, increasing the risk of **recurrent laryngeal nerve injury**.
🔸 Leak rate: 7.6% in THE vs 9.4% in TTE
🔸 Pneumonia: 13.8% (THE) vs 16.8% (TTE)
🔸 Bleeding: Less in THE
🔸 Cervical anastomosis in THE (Orringer’s stapled method) reduces leak to 3%
🟢 THE avoids thoracotomy but carries higher risk of nerve injury due to blind dissection.
Q3. Which is the most disabling complication after three field esophagectomy?
a) Bronchorrhoea
b) Recurrent laryngeal nerve palsy
c) Tracheal stenosis
d)
Answer: a) Bronchorrhoea
🔹 Three-field esophagectomy involves lymph node dissection in the **cervical, mediastinal, and abdominal regions**.
🔸 Japanese studies suggest better survival and prognosis with this approach despite increased extent.
🔸 **Respiratory complications** are most significant, especially due to **pneumonia and ARDS**.
🔸 There's risk to the tracheobronchial tree, especially if cautery is used near it — complications may be delayed.
🔸 Extensive lymphadenectomy increases risk to **recurrent laryngeal nerve**, **thoracic duct**, and **chyle leak**.
📚 Reference: SKF 8th Ed., Page 436
🔹 Three-field esophagectomy involves lymph node dissection in the **cervical, mediastinal, and abdominal regions**.
🔸 Japanese studies suggest better survival and prognosis with this approach despite increased extent.
🔸 **Respiratory complications** are most significant, especially due to **pneumonia and ARDS**.
🔸 There's risk to the tracheobronchial tree, especially if cautery is used near it — complications may be delayed.
🔸 Extensive lymphadenectomy increases risk to **recurrent laryngeal nerve**, **thoracic duct**, and **chyle leak**.
📚 Reference: SKF 8th Ed., Page 436
Q4. What is the most common complication after esophagectomy?
a) Arrhythmia
b) Pulmonary Collapse and Consolidation
c) Recurrent laryngeal nerve injury
d) Massive bleeding
Answer: b) Pulmonary Collapse and Consolidation
🔹 Pulmonary complications are **most common** post-esophagectomy, seen in about **32.8%** of cases.
🔸 Cardiac dysrhythmias: 10.9%
🔸 Persistent recurrent laryngeal nerve problems: 2.6%
📚 Source: [PubMed Central Article](http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1356512)
🔹 Pulmonary complications are **most common** post-esophagectomy, seen in about **32.8%** of cases.
🔸 Cardiac dysrhythmias: 10.9%
🔸 Persistent recurrent laryngeal nerve problems: 2.6%
📚 Source: [PubMed Central Article](http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1356512)
Q5. Most important investigation for preoperative evaluation of extensive corrosive stricture is:
a) Endoscopic ultrasound
b) Barium study
c) CT Thorax
d) Pharyngoscopy
Answer: a) Endoscopic ultrasound
🔹 **Corrosive stricture management** is based on phase:
- Emergency
- Intermediate
- Chronic/Long-term
🔸 Early phase: X-ray chest and abdomen rule out perforation
🔸 ICU care needed for severe symptoms — perform endoscopy under general anesthesia
⚠️ **Do not pass endoscope across area of injury** if signs of perforation
🔸 **Endoscopy is essential** for grading injury:
- Grade 1: Mucosal edema/hyperemia
- Grade 2A/B: Friability, erosions, ulceration
- Grade 3A/B: Scattered or extensive necrosis
🔸 Imaging like barium/CT is of **no immediate value** in acute phase.
🔹 **Corrosive stricture management** is based on phase:
- Emergency
- Intermediate
- Chronic/Long-term
🔸 Early phase: X-ray chest and abdomen rule out perforation
🔸 ICU care needed for severe symptoms — perform endoscopy under general anesthesia
⚠️ **Do not pass endoscope across area of injury** if signs of perforation
🔸 **Endoscopy is essential** for grading injury:
- Grade 1: Mucosal edema/hyperemia
- Grade 2A/B: Friability, erosions, ulceration
- Grade 3A/B: Scattered or extensive necrosis
🔸 Imaging like barium/CT is of **no immediate value** in acute phase.