Copied and back-posted from our CaringBridge site for permanent record here.
Day 20: Going Into Reconstruction Surgery Now
December 7, 2020, 4:40 p.m., written by Mama
We knew Thomas would likely go into surgery this evening and, after waiting all day, we just got the "go code" that Thomas will be headed into the OR in 30-45 minutes. Likely time for surgery: 5:10-5:25. No estimate on how long it will last because of so many variables.
We pray that the surgeon is able to do a complete organ reconstruction this time. Otherwise, the window of opportunity will close and Thomas's abdomen will be closed up and left to heal for 8-12 weeks before he would have to undergo reconstruction surgery.
Bonus prayers for the surgeon to be also able to install Thomas's PermaCath during this surgery. Nephrology needs Tom to have a PermaCath for moving onto intermittent dialysis. If the surgeon does not feel Thomas is stable enough to install the PermaCath now, then within a couple of weeks, Thomas will have to go into surgery yet again.
December 7, 2020, 11:10 p.m., written by Mama
Thomas's Surgery #6, which was his big Reconstruction Surgery, could not have gone better. The surgeon believes your prayers are helping!
In the big, exciting surprise: It turns out that Thomas has retained the majority of pancreas when the surgeon had thought he retained only the head, having lost the body and tail. Thomas's pancreatitis had caused the pancreas to swell and inflame so large that it turns out that what the surgeon had cut away was just inflamed dead nasty ick (I don't know the technical words) but that most of his pancreas has survived! This is so important for digestive enzymes and blood sugar control.
The Reconstruction Plan A is exactly what the surgeon was able to do. See diagrams.
The surgeon removed Thomas's gallbladder and common bile duct, which were both dead.
He reconstructed a new stomach out of intestine for Thomas, resulting in something in size rather similar to what someone with gastric bypass surgery would have. He reconstructed a new bile duct from the liver and a new duct from the pancreas to the intestines.
Thomas lost 300 cc blood, which is less bleeding today than in any surgery so far.
Thomas has three drains and still is left open, sealed with a WoundVac. The surgeon did not close the abdominal wall because he will have to go back in.
Today is Monday and it is planned that in two days on Wednesday 12/9, the surgeon will go back in to install the PermaCath for intermittent dialysis. The reason he would not do that today is that he was removing a dead gallbladder and if it had released infected matter into Thomas's bloodstream, it would have contaminated the line of the PermaCath. Also in that procedure, the surgeon will start trying to close the abdominal wall, but after being open so long, that may need to be a staged procedure, requiring several trips to the OR over days. It is important not to put pressure on Thomas's inner organs or his lungs by closing the abdominal wall too quickly.
One decision remaining is whether to put in a J tube just in case we have problems with starting nutrition. This would give us a back-up for starting formula nutrition if starting it via NG tube does not start easily.
The esophagus needs at least a week to heal before any nutrition goes down it.
When, oh when, will we see our beloved Thomas awake again?!
After the abdominal wall is finally closed (which might take days!), then maybe 24 hours later, the PICU team can start weaning sedation, leading to extubation . . . and then the withdrawal process begins anew!
We are so grateful for Tom's enormous network of thousands of prayer warriors around the country and even globally. Your love, support, and prayers have been both consoling and sanctifying. God has brought us all to our knees on Tom's behalf as He invites us all to greater holiness.
No comments:
Post a Comment