Upper GI Surgery

Question 1

Describe the indications of oesophageal cancer.

Answer 1

• Frequent and persistent hiccups
• Acid indigestion, heartburn, reflux
• Difficulty when swallowing food
• Constant burping, belching coughing
• Pain between shoulder blades
• Weight loss

Question 2

Describe the indications of gastric cancer.

Answer 2

ALARM symptoms (or >55 then OGD)

• Anaemia
• Loss of weight
• Anorexia
• Recent onset of progressive symptoms
• Masses and maleana/haematemesis
• Swallowing difficulty

Risk factors

• Infection with H. pylori
• Alcohol
• Smoking
• Excessive consumption of salted fish, pickled vegetables and cured meats

Question 3

Describe the indications for anti-reflux surgery.

Answer 3

GORD

• Painful burning sensations in throat or chest
• Dysphgia
• Sour taste in mouth
• Wheezing, asthma symptoms, chronic coughing, difficulty breathing
• Excessively salvating
• Tooth erosion
• Belching
• Chest pain

Question 4

Describe the principles of drug or surgical management of oesophageal cancer.

Answer 4

Metastatic/unfit

• Stenting
• Palliative radiotherapy
• Palliative chemotherapy

Resectable/fit

• Oesophagectomy and chemo (5 YS: 45%)
• Concerns about resection and no metastases: chemo/radio (5 YS: 30%)

Question 5

Describe the principles of drug or surgical management of gastric cancer.

Answer 5

• Subtotal gastrectomy
• Total gastrectomy and Roux-en-Y reconstruction
• Laparoscopic distal gastrectomy
• Open gastrectomy

Question 6

Describe the principles of drug or surgical management of anti-reflux surgery.

Answer 6

Investigations

• Endoscopy
• Oesophageal pH studies and manometry

Surgery
- Fundoplication

Question 7

Describe the approaches, conduits and moralities associated with oesophagectomy.

Answer 7

Approach

• Ivor Lewis
• Trans-hiatal
• Left thoracic-abdominal

Conduit

• Stomach
• Colon

Morbidity: 20-30%
Mortality: 5%
Return to pre-op QOL 10 months.

Question 8

Describe Roux-en-Y reconstruction.

Answer 8

• Jejunum is cut and attached to oesophagus.
• Proximal duodenum is sealed off and distal part is attached to jejunum 50cm below oesophagus to allow flow of bile.
  (Duodenum is fixed to pancreas so cannot be directly attached to oesophagus.)

Question 9

Describe the side effect of laparoscopic hiatus hernia repair and fundoplication (anti-reflux surgery).

Answer 9

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