Possible Future Surgeries

I'm sure there may be some issues that we can't yet foresee, but here are some possible future surgeries. None are a certainty, but none would be a surprise, either.

1) Stomach valve to reduce GERD (gastroesophageal reflux disease). Children with diaphragmatic hernias often have trouble eating post-operatively. This is because the diaphragm has a large role in keeping food going in the right direction. When food travels through the esophagus and down into the stomach, the diaphragm constricts so that the food is less likely to come back up. Since Andrew had very little diaphragm around his esophagus (though there was SOME), he may have this issue. The surgeon would go in and use his upper stomach to create a one-way valve to keep food in and prevent leakage.

2) Ladd procedure to reverse malrotation. When the intestines don't develop normally and in the correct place, they can't attach to the abdominal wall at the correct point, and often twist (malrotation). This twisting can cause a blockage, or allow "Ladd's bands" to form between the stomach and the small intestine. These are bands of tissue that keep food from traveling normally from the stomach to the intestine. During a surgery to correct these issues, the Ladd's bands are fixed and the large and small intestines are placed in the right location. During the hernia surgery, the focus was on getting everything removed from the chest cavity and closing him up before there was a problem with bleeding....mostly because of the ECMO. We'll have to wait and see how eating goes before we know if he needs either of these first two surgeries.

3) Diaphragm patch replacement. As I mentioned before, he may need to have the patch replaced later in life, most likely during puberty or near another major growth spurt. He has plenty of extra patch for years of initial growth.

None of these surgeries are anywhere near as major as the first, and none would have the additional complication of Andrew being on ECMO. How he responds to food in his digestive system will give us a better idea of his needs. I'll also talk to the surgeon about how he left the abdominal organs when he closed Andrew up the other day. It might give him an idea about percentage possibilities.