here we go again

Two weeks ago, Shawnie went in as requested (by the surgeon that did her nissen procedure in September) for an upper GI test to follow up with the report from the orthopedic doctor from her spine surgery that she had an enormous hernia in her diaphragm that appeared to have intestine in it.  That evening the surgeon called us and said it needed to be fixed right away.  He scheduled her on the first day that he had available and explained what he would need to do.

Apparently, the hernia that was repaired during the nissen procedure reopened and her stomach and intestines had pushed through into her chest cavity.  There were a few reasons that he explained that could have caused this to happen, but he had no idea until he went in what the specific reason was in her case.  By the end of the conversation, there were a wide spectrum of outcomes, ranging from best to worst.  Best case, he would go in the same holes that he made for the nissen, repair and patch the hernia.  Worst case, he would have to undo the nissen, lengthen her esophagus, make new holes or cut her chest open, as well as repair and patch the hernia and then redo the nissen.  He told us to plan on a week in the hospital; best case, three days, worst case, up to two weeks.

After driving through a horrific blizzard in Sardine Canyon, we arrived late to surgery registration.  They whisked us through all the paperwork and before we knew it, at about 11 a.m. she was gone. The nurse in registration told us as we left to plan on 2 hours.  The doctor met us at the door and explained once again all the possible scenarios and told us to plan on 4 hours.  They would update us hourly on the progress.

As they called down through the procedure, things just seemed to get worse and worse.  As a precaution, they had to put in two iv’s which took longer than expected, they had to undo the nissen, they had to pick through scar tissue carefully to pull the stomach and intestine out of the hernia and put it back where it belonged.  After four hours they called and this is the point they were at.  The nurse said to plan on at least another hour.

A few minutes later, the doctor called from the OR to let us know that after carefully checking everything out, they discovered that the cause for the recurrent hernia was that her esophagus was indeed short and would need to be lengthened.  He’s only done 10 or 11 in his lifetime and he’s an older surgeon.  We were SO worried and sad as this impacts her recovery in enormous ways.  It took three more hours to lengthen the esophagus, stitch and patch the hernia, and redo the nissen, for a total of 7 hours, making this the longest procedure she’s ever had in her life, even trumping the spine fusion!  Because of the length of the surgery and the intensity of the procedure, he decided to put her in icu instead of going to the floor, at least for the night.  About 6:15 last night, the doctor made it into the parent waiting room and spent the next hour showing us photos and explaining all the details of what had had to be done. Then he finally brought us to the icu to be with her.  He didn’t end up having to make an incision in her chest and was able to use all of the same holes from the first procedure except one new one that he had to make under her arm.  That one is the most painful of all.  He had to leave a great big tube in it to drain fluid to protect her lungs from infection.  She’ll have to deal with it for at least a couple of days until it stops draining.  She has an NG tube in her nose that is sucking blood out of her stomach and we are having to frequently suction out her throat to clear the thick blood.  She is not allowed to eat or drink anything at all for 5 days, so today they are coming in to put in a pic line that they can feed a special iv with calories into.  She is sad and discouraged and hurting today.  The first day is always the worst and I’m hoping by tomorrow she’ll be feeling a little better and that her spirits will be up.