Chapter 1952: 1884 Surgical Procedure Combined with Intervention = No Need for Second-Stage Surgery

You write the op note based on what you see? Your old man's endoscope is shaking like a big pendulum—what can you see!

"Do the operation properly. Doctor Xia, clear the pus and tartar, about 900ml." Zheng Ren said.

"Oh, oh." Xia Hua hurriedly wrote it down.

"Next, lyse the adhesions, then we should open the inferior pulmonary ligament." Zheng Ren continued.

"Uh... we've come this far?"

Xia Hua stared hard at the screen, trying to find the shadow of the inferior pulmonary ligament.

The position they were working on looked somewhat like it, but the scope was too close, lacking an overall view, so he couldn't tell if they were cutting the inferior pulmonary ligament.

After Zheng Ren lysed the inferior pulmonary ligament, he opened the mediastinal pleura.

The dissecting forceps were as nimble as fingers, quickly exposing the esophagus in the field of view.

"Move slowly, let Doctor Xia have a look, otherwise we won't be able to write the op note." Zheng Ren said.

"Just make it up, it's all the same process anyway." Su Yun said.

"Here, Doctor Xia, see? The esophagus has a defect, about 2cm long. The surrounding tissue is fragile, can't do a primary repair." Zheng Ren said.

Xia Hua looked carefully; after Su Yun pulled back the scope, he saw a defect in the esophagus about 5cm above the cardia, the area around it was pale white with a bit of pus coating.

Esophageal suturing is inherently difficult because the esophageal wall is weakly elastic; forced suturing creates high tension, poor local blood flow, and necrosis easily occurs postop.

Xia Hua was still estimating what kind of drainage tube to leave in the defect to draw out the thick fluid and exudate, to prevent further infection in the thoracic cavity and mediastinum.

A second-stage surgery would be needed—that was Xia Hua's first judgment.

But choosing the timing for a second-stage surgery is difficult, and esophageal second-stage surgery differs from gastrointestinal.

If the intestine had a similar problem, it'd be easy—just make a stoma. It's an abnormal bowel outlet; patients may find it uncomfortable at first and need time to adapt.

But if they wait for a second-stage esophageal surgery, the patient would have to rely on nasogastric feeding or parenteral nutrition for sustenance.

How would we guarantee nutrition?

"Doctor Xia, you help Su Yun finish the rest of the work." Zheng Ren said.

Xia Hua began to worry. At that moment, Zheng Ren's voice reached his ears; he startled, then replied offhand.

"Uh... what about you?"

"Hey, have you listened to the case analysis?" Su Yun was really unhappy this time; if Zheng Ren hadn't stepped down and bumped his arm, the hemostatic forceps left from when they almost started would have flown over.

"You really intend to do a second-stage surgery you're not sure about?" Su Yun said contemptuously, "Place the covered anti-reflux stent; patients can eat after 7 days postop, and the stent can be retrieved in 14–28 days depending on the situation."

Xia Hua listened quietly, feeling sure something was wrong—either his understanding or his cognition was off.

In short……

The problem lies with himself, not with Zheng Lao Ban.

Covered anti-reflux stent—what does this consumable mean? Xia Hua could understand it, but he'd never seen one.

It should be a bag that stops gastric reflux, preventing the stent wall from being eroded and leaking.

But after placing the stent, can it be retrieved in 14–28 days postop? Can the esophagus grow over it?

"And then what?" Xia Hua asked.

"Then we'll see—if the esophagus can grow over it, great, the surgery succeeds and the patient is discharged. If not, although unlikely…… how capable is your endoscopy suite?" Su Yun asked.

…… Xia Hua completely didn't understand what this new technique was.

"They probably haven't encountered this before." Zheng Ren called Gao Shaojie to help, then explained: "Postop nutrition must be kept up; a 2cm esophageal defect should easily epithelialize. If really not, later the edges won't be so fragile, and we can solve the problem with endoscopic suturing technique."

Xia Hua remained bewildered.

"We'll decide later; if it fails, send the patient to Di Du to find me, or I'll come back again. This situation is unlikely; it should heal, no need to worry." Zheng Ren said.

"Zheng Lao Ban, this stent is too advanced." Gao Shaojie said while measuring the covered anti-reflux stent.

"Yeah, it's specially made to prevent gastric reflux. Normally it's hardly used, so not seeing one isn't strange." Zheng Ren laughed.

Because the patient's condition differed from Xia Hua's father's, the guidewire went straight in.

"We're about to step on the line, close the door." Zheng Ren said.

Gao Shaojie noticed Feng Xu Hui hadn't left; instead, he stayed in the operating room wearing lead clothing.

This kid really has a future! Even with the line on him, he wants to stay in the OR, unwilling to leave Zheng Lao Ban's side—Gao Shaojie thought.

He regretted it for the ten-thousandth time, but if he could do it again, he couldn't abandon his son who's about to take the college entrance exam and Zheng Lao Ban to go to Di Du.

That's fate!

Gao Shaojie mused while swiftly preparing to deploy the stent.

After just one line check, the covered anti-reflux stent reached position; Zheng Lao Ban didn't even measure, just opened it.

"Position just right, perfect!" Su Yun stood at the surgeon's spot and touched the esophagus with the forceps.

The covered anti-reflux stent had completely sealed the esophageal defect, with no gaps; a few centimeters up and down, the overall placement was exactly as he said—perfect!

Gao Shaojie froze.

Placing an esophageal stent looks simple, but there's still a knack to it. The upper/lower position, deployment force, and various details absolutely determine postoperative patient quality of life.

Zheng Lao Ban's stent placement was just right; judging by Gao Shaojie's years of rich clinical and surgical experience, it was the ideal spot.

Who would've thought the surgery could be done like this! It looks thoughtless, but Gao Shaojie knows it's the embodiment of countless surgical experiences.

It looks easy, but who knows how many times Zheng Lao Ban has honed this.

Gao Shaojie felt moved inside.

Preop diagnosis clear, assessment accurate, intraop actions clean and swift—surgical plus interventional procedure—turned a patient who originally needed a two-stage surgery into a case likely doable in one go.

Awesome!

Gao Shaojie felt moved inside.

With Zheng Lao Ban daily hammering with the hemostatic forceps, Old Liu must have gotten incredibly strong, right? Gao Shaojie kept feeling regret.

"Old Gao, I'm stepping down now." Zheng Ren finished placing the stent, turned, and stepped down.

"Oh." Gao Shaojie hurriedly responded.

The esophageal stent itself wasn't a major Shou Bing, there wasn't much to do after the Shou Bing, Gao Shaojie busily wrapped up.

"Doctor Xia Hua, the Shou Bing process is roughly like this. After the Shou Bing, strengthen nutrition, no water for 7 days." Zheng Ren reminded again worriedly.

"Mm-hmm." Xia Hua gradually understood the whole Shou Bing process.

Excluding this sarcastic, effeminate assistant nearby and the dazzling yet dizzying operation, the Shou Bing was practically perfect!