Surgery Details

Let's get this out there right now...he's still on the ECMO...more below.

Drew's surgery took a few hours (if not more) to complete. The reason is that there was very little diaphragm remaining on which to attach the patch. The surgeon had to rush off to another procedure, but the other attending doctor said that there was only a rim of muscle available around the edge of the abdominal cavity. The hernia also went from his left side all the way to his midline.

The downside to having so little to work with is that the diaphragm won't work on his left side for a long time, if ever. The muscle should stretch and make up for some of the slack later in life, but there's no guarantee. There's also a higher risk of a repeated hernia, though if it happened again it would be relatively minor (he would probably notice some trouble breathing) and would be a pretty simple fix. If it happened, it wouldn't be until later in life, so it'll just have to be something we keep in the back of our minds.

The organs included in the hernia were the stomach, intestines, a bit of liver, and a bit of spleen. There was a little bleeding from the spleen initially, but they quickly got it under control. There was no bleeding (to speak of) from the incision, the liver, or other organs. They were able to get all the organs down into the abdomen without any trouble, and they haven't seen anything in the way of surgery complications.

They took a chest X-ray after the surgery and saw a good amount of left lung...a little more than a third of his chest cavity on that side. It will take a while to determine the state of development and/or growth of that bit, but it's certainly more than the nubbin it could have been.

As I mentioned, he's still on ECMO for a few hours. They'll do another trial to see how he responds sometime this afternoon. That will tell them what sort of support he'll need from the ventilator. The options that can be modified are: percent of oxygen, nitric oxide (or not), and high frequency vent (or not). I'm guessing there's a 70% chance he'll need the hi-fi vent, but the hope is that he'll have some cushion room so there's a fall-back instead of ECMO.

We just saw him again and he still looks good. He'll be sedated for a full day to make sure he doesn't hurt himself, but I'll be sure to get pictures after the ECMO comes off. I'll post another update after the next surgery.