Upper GI Surgery

Question 1

What are the side effects of laparoscopic hiatus hernia repair?

Answer 1

• Dysphagia
• Difficulty to belch and vomit
• Gas bloating
• Excess flatulence
• Diarrhoea

Question 2

What is bariatric surgery?

Answer 2

Refers to all surgical procedures utilised to achieve reduction of excess weight

Question 3

What are the three types of bariatric surgery?

Answer 3

Restrictive
Malabsorptive
Combination

Question 4

Describe purpose of restrictive bariatric surgery

Answer 4

Decrease size of stomach leading to satiety with smaller volumes of food hat eventually leads to food intolerance and weight loss

Question 5

Name types of restrictive bariatric surgery

Answer 5

• Synthetic gastric band
• Stapling
• Size reduction by ‘sleeve gastrectomy’

Question 6

Describe purpose of malabsorptive bariatric surgery

Answer 6

Bypassing segments of bowel, which thereby cause malabsorption of nutrients

Question 7

Describe purpose of combination bariatric surgery

Answer 7

Involves both aspects of restriction and malabsorption - such as Roux-en-Y bass (considered gold standard)

Question 8

What is the process of Roux-en-Y surgery?

Answer 8

Creates stomach pouch out of small portion of the stomach and attaches in directly to the small intestine, bypassing a large part of the stomach and duodenum

Question 9

What are the advantages of laparoscopic adjustable gastric banding?

Answer 9

• Minor surgery
• Reversible and adjustable
• Low operative complication rate
• Mortality 0.1%

Question 10

What are the disadvantages of laparoscopic adjustable gastric banding?

Answer 10

• Requires implanted medical device
• Risk of prolapse or slippage
• 15% require revisional surgery

Question 11

What are the advantages of a laparoscopic gastric bypass?

Answer 11

• Quick and dramatic weight loss

* Dumping syndrome

Question 12

What are the disadvantages of a laparoscopic gastric bypass?

Answer 12

• More invasive surgery
• Malabsorption component requires lifelong supplements
• More complex if requires revision
• Mortality 0.5%

Question 13

What is a laparoscopic sleeve gastrectomy?

Answer 13

Partial gastrectomy which results in the removal of the stomach, with the remainder looking like a ‘banana’

Reduced size inhibits distension of the stomach so that it becomes fuller sooner, thereby increasing the patients feeling of fullness and decreasing appetite

Question 14

What are the advantages of a laparoscopic sleeve gastrectomy?

Answer 14

• Good medium-term outcomes
• No dumping syndrome
• No small bowel manipulation
• No foreign body

Question 15

What are the disadvantages of a laparoscopic sleeve gastrectomy?

Answer 15

• More invasive surgery
• Long staple line
• Mortality 0.4%

Question 16

What are the possible complications of a laparoscopic sleeve gastrectomy?

Answer 16

• Anastmotic leak
• DVT/PE
• Infection
• Malnutrition
• Vitamin and mineral deficiencies
• Hair loss
• Excess skin