My Medical Skills Give Me Experience Points

Chapter 1401 - 557: Destruction Is Not Injury, the Comforting Anesthesiologist

After getting a clear understanding of the patient’s gastric condition, Zhou Can felt more assured.

"Please show me the pre-operative esophageal imaging of the patient again."

He wanted to use this opportunity of performing an endoscopy to precisely locate the esophageal fistula, and ideally, identify the true cause behind its formation. This is essential to ensure that it does not recur after the second surgery.

"Here is the esophageal imaging done for the patient today. The fistula opening exceeds 1cm!"

Director Tan spoke these words with some embarrassment.

The entire esophageal rupture was about 6cm in size, and now the opening of the fistula is over 1cm, making it hard for him, as the lead surgeon, to evade responsibility.

When Zhou Can manipulated the endoscope to withdraw, he meticulously searched for the fistula location shown on the imaging, exerting considerable effort before he finally found it.

From the inside of the esophageal wall, the fistula was not very evident.

This position was located at the base of the suture tear, with some signs of infection causing the sutures to burst.

Relying on his surgical experience and Level 6 Suturing Skill, after careful observation, Zhou Can confirmed that other parts of the esophageal tear had initially healed. This was a positive sign.

Therefore, there was no need to touch it again.

To repair this fistula, debridement and then re-suturing would definitely be required.

Firstly, there is no guarantee that after suturing, there won’t be any reinfection or suture bursting.

In fact, once the esophageal wall is infected, even if it doesn’t fester, it’s still easy for the sutures to burst open again.

Even optimistically, if Zhou Can, with his Level 6 Wound Cleaning Skill and Level 6 Suturing Skill, repairs the fistula and it heals directly without bursting open again, it would still significantly impact the patient.

What kind of impact?

The patient’s esophagus had already become sclerosed, brittle, with significantly poor elasticity and toughness. This means the maximum size of food that can pass through is much lower than normal levels.

Then, a few days ago, a tear, 6cm long, occurred in the esophagus that was sutured, causing the internal space of this section of the esophagus to significantly narrow.

Just now during the endoscopy, Zhou Can could feel it.

The section of the esophagus repaired was noticeably narrower.

This will definitely affect the patient’s post-operative eating, making it very easy for them to choke.

If further debridement and re-suturing are performed on this narrowed basis, the space in this section of the esophagus will become even narrower.

Afterwards, the patient may only be able to consume liquids.

And they would have to be very thin liquids; anything too thick would immediately clog the esophagus.

Plans just can’t keep up with changes!

Checking this endoscopy was indeed very necessary.

If the patient’s condition hadn’t been carefully understood and a thoracoscopic surgery was performed directly to repair the esophageal fistula, even if the surgery was successful, it would definitely be a failed operation.

"I wonder what kind of second surgery your hospital is planning for the patient?"

Zhou Can asked Director Tan and Song Qian.

It’s crucial to first consult the opinions of the hosts.

"We invited Dr. Zhou over to help clean up this mess, so naturally, we’ll defer to Dr. Zhou’s judgment." Song Qian replied on behalf of Director Tan.

"Since the fistula opening isn’t large, it would be best if it can be repaired based on the existing surgery. Before coming, the surgical plan proposed by Dr. Zhou was to repair it via thoracoscopic surgery. This plan causes less trauma to the patient and belongs to minimally invasive surgery, which I fully agree with."

Tan Shengli’s surgical thinking seems to be rather old-fashioned and conservative.

This type of surgical mindset prefers a step-by-step approach when planning surgeries.

The advantage is stability, but the downside is a lack of flexibility, being quite rigid.

"Before coming, I indeed thought of doing thoracoscopic surgery to directly repair the esophageal fistula. However, during the endoscopy just now, I discovered an issue; the esophageal fistula occurred in the segment from the last rupture. If a second suturing is carried out, I’m concerned it will greatly impact the patient’s post-operative quality of life. Hence, I am inclined towards an alternative solution."

Zhou Can possesses a Level 6 Pathological Diagnosis skill, which greatly aids in crafting a more optimal surgical plan.

"Is there another solution?"

Director Tan’s eyes lit up slightly, while Song Qian’s beautiful eyes glittered.

"Currently, with the patient developing an esophageal fistula, ensuring nutritional support becomes an urgent issue that needs addressing. If nutrition is not assured, wound recovery will slow down significantly, and the body may develop various problems. If it reaches that stage, his situation becomes extremely dangerous."

Zhou Can explained the underlying reasons to everyone.

Currently, the patient experiences immediate leakage whenever he eats, with only a small portion of food reaching the stomach. Food escaping through the esophageal fistula all enters the thoracic cavity, and even though a chest drain is placed during surgery, there remains a major safety hazard in the thoracic cavity.

If thoracic cavity infection occurs, even the most advanced antibiotics may not save the patient’s life.

"Dr. Zhou, may I interrupt and ask what do you think are the reasons behind the patient’s esophageal fistula?" Tan Shengli, after listening, seemed to have a flash of inspiration in his surgical thinking and interrupted Zhou Can.

"During the endoscopy just now, I observed ulcers in the esophagus along with redness and swelling. I suspect that the cause behind the failure of the esophageal repair was the esophageal wall edema and inflammatory necrosis, which caused the sutures to burst, leading to non-healing of the wound."

Zhou Can could only speak truthfully.

This situation occurs from time to time and is somewhat related to the surgical quality of the operating doctor. For example, the control of post-operative edema can be addressed with preventive measures if this occurred at Tuya Hospital.

"Alright, then please continue with your treatment plan!"