Chapter 816: with translation of chapter title

Jiang Zong carefully examined the blood‑stained metal sphere.

Don't remove the Hemostatic Forceps; if it's not enough, just make another cutting pack. Zheng Ren instructed.

Who the hell knows what this thing is—no connective tissue entanglement; if the Hemostatic Forceps are loosened and the metal blade retracts, any further strange change would be disastrous.

Jiang Zong replied cautiously, letting the instrument nurse place a layer of cotton padding on it and then set it far away, lest it really burst out and hurt someone.

The unknown landmine had been ruled out, but the surgery had only just begun.

Zheng Ren used the Suction Device to aspirate blood, observed the patient's peritoneal cavity, and found no other metal objects.

After confirming this, Zheng Ren grew bolder, reached in, grasped the splenic pedicle, and began to cut the spleen.

After mobilization, clamping, transection, and suturing, the shattered spleen was quickly removed.

He placed it in a tray; Zheng Ren did not rush to the next step but began to examine the spleen.

"Jiang Zong, where are you from?" Zheng Ren suddenly asked.

"I'm from Di Du," Jiang Zong replied, somewhat puzzled.

"Have you ever gone hunting?"

"……" Jiang Zong stared for a moment—hunting? What the hell is that?

"I think this wound and the metal sphere just removed look like something fed to large livestock."

"What?" Jiang Zong still didn't understand, but Zheng Ren's comment made him imagine it.

The metal sphere is wrapped in meat and dough mixed with sesame oil, fragrant, then tossed where large livestock roam in the wild.

The so‑called large livestock usually refers to wild boar. Bears are now protected, few in number, and hardly hunted. Although wild boar are also protected, they reproduce far faster than bears and are already near plague levels.

Once ingested, the metal sphere expands, shredding the stomach; wild boar and other large livestock die from unstoppable bleeding.

Although the metal blade on one side of the sphere deploys while the other side does not, Zheng Ren still felt his guess was correct.

Such devices have been updated, but the principle remains much the same.

Jiang Zong also figured it out in his mind.

"Was this kid forced to swallow it or did he eat it himself? How bold can one be!" Jiang Zong exclaimed.

"I don't know." Zheng Ren placed the spleen, which had made a huge wound, into the pathology basin and began to look for liver lacerations.

The liver had several deep lacerations, but because the hepatic hilum was encircled, bleeding was minimal.

He sutured the liver with absorbable thread, released the hepatic hilum obstruction, observed for thirty seconds, saw no ongoing bleeding, and then relaxed.

With hepatic and splenic bleeding controlled, the real focus remained.

The stomach had already been opened; due to the gastric bypass, the stomach and intestine were also damaged. This is a major task, needing meticulous handling.

"Zheng Lao Ban, is this post‑gastric bypass surgery?" Jiang Zong, now understanding the patient's condition, asked in surprise.

"Yes."

"An open procedure? I thought the patient had undergone other surgeries before—what's going on?"

Jiang Zong wasn't very clear, but Zheng Ren understood what he meant.

Gastric bypass surgery is now done laparoscopically, with a simple technique and minimal trauma, yet this patient underwent an open operation.

After 2000, gastric bypass surgery replaced stomach stapling and became the most popular weight‑loss surgery in the United States, with about 100,000 cases performed each year.

In 2004, the U. S. National Institutes of Health further included gastric bypass surgery in the national health insurance, officially recognizing it as the most effective weight‑loss surgery.

Over a decade later, gastric bypass is almost always done minimally invasively via laparoscope; that this child had an open operation explains Jiang Zong's surprise.

Zheng Ren offered no explanation and simply continued the surgery.

Bleeding points on several solid organs were either excised or sutured, and the patient's bleeding had basically stopped.

With the infusion of fresh frozen red blood cells and plasma, the patient's blood pressure gradually rose.

The surgery was no longer so urgent.

The principle of gastric bypass surgery is to cut the greater curvature of the stomach, reduce its volume, and then rearrange the intestinal tract.

The procedure divides the stomach into a smaller upper portion and a larger lower portion, then transects the small intestine and re‑positions it to alter the food's path through the digestive tract, slowing gastric emptying, shortening the small intestine, and reducing absorption.

This surgery carries a relatively high risk of postoperative intestinal adhesions and obstruction, since the bowel has to be re‑routed.

Although the surgeries performed at the Xianggang Underground Black Clinic are fairly standard, they are open procedures with relatively large trauma, leading to more severe adhesions.

The surgery preserved the gastric pylorus, measured 25 cm proximally on the jejunum, where a laparoscopic linear cutter‑stapler should have transected the intestine, but the operator simply cut it directly.

After suturing, adhesion at this site is relatively severe.

Seeing this degree of adhesion, Jiang Zong's brows furrowed immediately.

What is most feared in gastrointestinal surgery? Certainly adhesions.

Even a pancreatoduodenectomy isn't the most troublesome GI or hepatobiliary operation; the truly "worst" procedures are intestinal adhesions and obstruction.

Moreover, regardless of the surgeon's skill, the operative duration cannot be predicted beforehand.

Because the adhesions are so dense, separating them requires caution to avoid tearing the bowel, especially testing the surgeon's technique.

Jiang Zong suddenly felt a sense of apprehension.

Zheng Ren didn't dwell on it, requesting the Hemostatic Forceps and Blunt Scissors. Using the forceps to traction, the blunt scissors either mobilize or transect, and sometimes he holds the scissors in his hand, using his fingers to mobilize and loosen the adhesions.

Jiang Zong could initially assist, but soon couldn't keep up with Zheng Ren's pace and thought process; however, Zheng Ren was accustomed to operating alone, so nothing was delayed.

"Zheng Lao Ban, your general surgery skills are also this proficient." While performing the surgery, Jiang Zong remarked: "I heard Brother Wang say that half a year ago you helped him with an open polypectomy for P‑J Syndrome. I thought your level was high, but I didn't expect it to be this high."

"Not bad." Zheng Ren remarked casually while mobilizing and loosening the intestinal tube.

He didn't pay much attention to Jiang Zong's words; instead, he was pondering how to handle the tumor in the patient's duodenal bulb.

After freeing the adhesions at the duodenal‑jejunal transection site, Zheng Ren found several lacerations and sutured them promptly to avoid missing any.

The surgeries at the Xianggang Underground Black Clinic are actually standard; they're just not minimally invasive.

After mobilization and loosening, the anatomic structure gradually became clear.

The operator in Xianggang measured 150 cm distally from the jejunal transection end and marked it with a suture.

The proximal and distal cut ends of the jejunum are positioned 150cm apart and fixed with sutures; an incision is made at the mesenteric edge of each intestinal segment, then a jejunojejunal side‑to‑side anastomosis is performed, the anastomotic opening being about 6cm.

Finally, a small incision is made in the mesenteric root below the colon, the sleeve stomach is passed through below the colon, and the distal lateral side of the jejunal cut end is sutured to the distal end below the pylorus of the sleeve stomach with sutures, performing an end‑to‑side anastomosis.

Even if the idle intestine is scratched, it's no problem; this segment of intestine has already lost its original digestive function.

After examining the intestinal perforation, Zheng Ren pondered the duodenal bulb.