Option 1 (and the most ideal option): Pull the lower portion of his esophagus up and attach it to the upper portion. This is not a likely option based on the assessment this past Monday of how much had been removed. However, it is not off the table. There is still a possibility that this will work, and that gives us ample hope that surgery could go the least complex route. While we are extremely realistic about the likelihood that this is the option used, this is the option that we pray for because, the reality is, the person truly in control of all of this can make it possible. We pray for the best possible outcome over the long haul and hopefully that can be reached by suturing his esophagus back together.
Option 2: If there is simply too large of a gap to span to pull the esophagus back together then they will use a piece of his jejunum (a part of his small intestine). Because there is such a length of intestine, a small piece wouldn't be missed. It also fits better and they can use the incision he already has in his belly from the G button placement to access the jejunum. The downside is that the vasculature can be extremely difficult to use. If the vasculature looks too small and likely to fail, or they use this option and the blood supply isn't sufficient, they will move onto...
Option 3: A segment of his colon. This option would allow them to pull the blood supply up with the segment being used which would obviously give a good probability of long term success. The downsides include that the colon is slightly more difficult to match with the esophagus in terms of size. Also, this option would require an additional incision in his chest and a chest tube - all of which create another thing that could get infected.
Option 4: Bypass everything and attach his stomach directly to his esophagus. This is a worst-case scenario option. They have this plan in place, but we didn't go into much discussion with this option because the likelihood of making it to this stage is slim. Anatomically, everything is as it should be so there would have to be some major hiccups in order to get here. We have faith that this is the one contingency plan that we won't encounter.
If they use option 2 or 3 we should know within the week if everything has a sufficient blood supply. He will likely come back from surgery intubated and, when it is time for extubation, the current consensus is that it would be best to take him back to the OR for safety and so that they can take a look at his airway. At some point he will have a swallow study and possibly some other tests to see how the repair is working. We were told there will likely be some leakage after the repair until the scar tissue seals everything off completely, but that is not unexpected and we can deal with that when it happens.
The bottom line is that any option used will result in him being able to eat by mouth again. However, each option has a different healing rate and the length of time before he would be able to eat by mouth increases as we move through the contingencies. Based on that, we will focus on where we are going to, not what the journey will look like or how long it will be.
The procedure should take approximately 6-12 hours, with the large variance in time being based on how many options they have to work through. He is supposed to head down to the OR at 7:30, so I would anticipate he will be in surgery within 2 hours of that. I will update the blog as I have information throughout the day.
As far as his day today, he did not have a fever all day (WOOHOO!). His CO2 was slightly high, so he was given a rate back on his vent to help him blow that off when he exhales. His CO2 has started to come back down within normal limits. His hemoglobin was up today, but still low. We are anticipating a blood transfusion on Sunday to prepare him for surgery (and likely another during and/or after surgery to compensate for blood loss during the procedure). We are still having some challenges with pain control, but nothing too crazy. One of his medications is currently being withheld as a bolus, or intermittent dose, but he is still getting the continual rate. The medication bolus is being withheld due to low blood pressure because it can cause a further decrease in his pressure. After he moved all of the excess fluid off he has had a low pressure so he is getting a fluid bolus, or specified amount - not fluid that will run continuously, to compensate for that. He has other medications that can be bolused for comfort in the mean time.
I won't lie, I'll be glad when Tuesday is here and, while I don't want to wish away his childhood, I'm looking forward to the normalcy that will hopefully be part of our life by this time next year. But, for now, I'll focus on Monday.
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