7/19/2013

7/19/2013

Answers:

All of these are common complications of esophageal atresia and TEF repair except.
A) Fistula formation 
B) GERD 
C) Tracheomalacia 
D) Anastomotic Leak 
E) Anastomotic Stricture

GERD, Tracheomalacia, and Anastomotic leak/stricture are all common complication of atresia/TEF repair.

What is the benefit of a thoracoscopic repair for atresia/TEF compared with an open repair?

Complication rates of thoracoscopic approach are much lower.

MC Question:

What two muscles make up the upper esophageal sphincter?
A) Cricothyroid and Inf. Constrictor 
B) Cricothyroid and Sup. Constrictor 
C) Cricopharyngeus and Inf. Constrictor 
D) Cricopharyngeus and Sup. Constrictor 
E) Cricopharyngeus and Esophageal Crus

Free Response Questions:
The superior third of the esophagus is composed of --- muscle whereas the inferior two thirds of the esophagus is composed of --- muscle.

Quick Facts:
Pharyngoesophageal Diverticulum (Zenker)
-From posterior wall of esophagus in killian triangle.
-Killian triangle = cricopharyngeus inf and inf constrictor superiorly.
Signs/Symptoms
-Dysphagia (most common), regurgitation of undigested food, halitosis, hearing gurgling in neck.
-Barium swallow can clearly show position and size of diverticulum
-Manometry can show hypertensive UES and lack of coordinated contractions.
-Treat with excision of diverticulum and myotomy of cricopharyngeal muscle via cervical incision.
-Recently transoral endoscopic management has increased. Wall of diverticulum and cricopharyngeus is divided w/ staples/laser/cautery. Staple is preferred because it seals the cut edges of the wound, but only for short diverticula as stable device cannot advance staple line to end of sac.
-Prognosis is excellent