Surgery Details

The surgery will be approximately what we were expecting when we first heard about the bowel obstruction on Tuesday, but here are some more specifics. After talking to the doctor, he's relatively sure that the issue is something called Ladd's bands, which are bands of tissue attaching the large intestine to the abdominal wall. With diaphragmatic hernia patients, this attachment happens in the wrong place, because the organs form in the wrong location. In their new location, they obstruct the duodenum, which is the first portion of the small intestine, just below the stomach. This causes bile to move up into the stomach and prevents any food from progressing through the digestive system. This can happen with any child that has malrotation, which is almost always present in hernia patients, but is also common (1 in 500) in other children. Malrotation and Ladd's bands are so common that there is a by-the-book solution that almost always fixes the issue. Here's the process:

1. Make an incision in the abdomen. Unfortunately, the location of Andrew's first scar isn't a good place for this sort of procedure, so he will likely get a new incision down his midline, from just below his solar plexus to just above his navel.
2. Identify the Ladd's bands and cut through them to detach them from the abdominal wall.
3. Remove the appendix. Because of the next step, an existing appendix would be misplaced and would confuse any future doctors trying to diagnose appendicitis.
4. Re-pack the intestines into the abdomen in a manner that prevents similar problems from reoccurring. The small intestine goes on the right side, and the large intestine goes on the left.
   
5. Place a gastrostomy tube in the stomach. This is a simple addition (small slice and insert) that will allow us the maximum flexibility when it comes time to attempt feedings again. He can be fed orally, then given any additional nutrition he needs through the G-tube.
6. Close him up.
   

Currently, the focus is just on the above tasks, which should sort out his lower digestive system. He still may have reflux issues in the future, for which he might need another surgery called a Nissen fundoplication. This procedure will be considered during Friday's surgery, but it will depend entirely on whether there are anatomical signs that reflux will be an issue. If not, they'd like to give him as much opportunity as possible to feed naturally and not perform any unnecessary operations.

The surgery will take a long time, due to the sheer number of tasks and the complexity of the bowel. We'll get more details from the surgeon on Friday morning and I'll try to post updates whenever I know anything, but we're probably looking at late Friday afternoon before we know how it went.