We were anticipating the surgery to last 4-6 hours today, but it ended up taking 10 hours. As I mentioned earlier there were two main stages to today's operation: 1. removing and correcting existing issues and 2. finding a way to close the incisions.
First and foremost, Dad's PMP mucus was nowhere to be found. It seems like he is still cancer-free, although the battle has always been with the surgery not necessarily the disease. So what happened during the surgery?
The first stint was 7.5 hours long and the following actions were taken by Dr. A and his team: the part of his stomach that contains the fistula was cut and removed, "fasteners" were used inside and out to make sure the stomach flesh would heal to itself; the small intestine tissue that was originally connected to the stomach back in April was resected--about 3 inches were removed so that healthier intestine could be reattached to the stomach; his ostomy was successfully reversed and, again, older small intestine was removed (about 2 inches) so that healthier tissue could connect his small intestine with his large intestine; the ostomy itself was repaired and the hole in the skin was closed up; the doctor identified that his large intestine was healthy and looked good; there were no visible signs of trouble with the liver, affirming the assumption his hepatitis is TPN induced (we may know more once the labs come back on the liver); the G/J tube was replaced with a new sterile feed line. Because there was some scar tissue and "sticking" of the organs to one another Scott will most likely have some inflammation in his chest, so he has a drain tube in his abdomen for any fluids that might build up.
Once this major surgery was complete, major plastic surgery was next and it lasted 2.5 hours: Dr. K reinforced the sutures closing the ostomy site with additional skin grafts (the more the better!); he mentioned the fistula hole was small enough to heal on its own; and then came some really interesting medicine: because his new incision was in the same place as his old incision (from rib cage to below his belly button) the doctor had to remove all scar tissue making the "gap" even larger, and it is this gap that is very difficult to close without help.
You see, a complete close-up requires two main components: 1. a muscle-like base to hold one set of sutures and 2. the fat/skin base that might hold additional sutures or staples. Dr K "released" two of Scott's muscles in his stomach, brought them toward the center of his belly to create a base for the sutures, which established the incision's bottom half for muscle base. The top-half base was creating using acellular human skin grafts, doubled-up and connected to healthy tissue, like a patch over the gaping hole in his chest. Then they very carefully "pulled" his top layer of skin together over his entire incision site and closed him up (this time for good!!). There is still exposed graft; the idea being that his own skin will blend with the graft healing completely.
So, after 13+ hours of prep and time in the OR he is now recovering in the ICU. His vitals are normal. Allie and I are looking forward to seeing him tomorrow morning!
I'll update more as I am able.
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