Chapter 981: 960 Patch Repair

After all, it wasn't a surgery I performed myself, so the patient's thoracic and abdominal cavities' exact condition cannot be guessed from the surgical record.

When Zheng Ren worked in the General Surgery Department of Haicheng Shi Yiyuan, he had encountered such a patient.

After a cesarean section, the patient suddenly bled heavily. The doctors at the Township Hospital performed an emergency laparotomy and discovered that, during the cesarean, they had somehow punctured the spleen.

This was clearly a medical accident, but the strange events didn't stop there.

After an emergency splenectomy, the patient later developed breathing difficulties. A chest CT revealed left diaphragmatic hernia, pneumothorax, and lung tissue compression.

The director of the Township Hospital panicked and hurriedly sent the patient to Haicheng Shi Yiyuan.

To them, Haicheng Shi Yiyuan was their superior hospital, their heaven.

Liu Tianxing got along well with the Township Hospital's director, so he took charge of this patient and helped clean up the mess.

Upon examination, they found a large amount of pneumothorax in the patient's left thoracic cavity.

They consulted the thoracic surgery department together and discovered that, during the splenectomy, the diaphragm had somehow been punctured, causing a lung rupture.

After a round of repairs and suturing, the patient was finally discharged smoothly half a month later.

The doctors at the Township Hospital truly lack skill, just as physicians from major tertiary hospitals in Di Du and Modu would look down on Haicheng Shi Yiyuan.

This is a gap in technical skill, and there's nothing to be done about it.

Zheng Ren still can't fathom how a cesarean could puncture the spleen, or how removing the spleen could lead to lung and diaphragm rupture.

This is just damn terrifying.

Encountering a doctor with low skill is truly playing with one's life, but we can't expect every doctor to be highly skilled—that's unrealistic.

This is also Zheng Ren's main purpose in opening the Surgery Livestream Room: when faced with issues, he simply does his best.

The current patient's situation resembles that of the female patient Zheng Ren encountered after her cesarean, but the actual circumstances are not the same.

Upon seeing the image, Zheng Ren instantly concluded it must be a hepatic hernia, without doubt.

This is something that secondary injury can cause, definitely so, but it's not a low-level mistake by the doctor that makes one sigh. Rather, it's due to the rarity of congenital retrosternal diaphragmatic hernia, combined with the patient's older age and weak diaphragm.

Zheng Ren made the judgment immediately.

Cui Lao put on his reading glasses and began examining the films frame by frame.

Soon, the Emergency Department's Director Ren, the Gan Dan Wai Ke's Director Zhang, and the Thoracic Surgery's Director Li also rushed to Cui Lao's office.

Seeing Zheng Ren present, they all froze for a moment.

Director Zhang chuckled and said, "Zheng Lao Ban, that surgery you just performed was truly beautiful!"

"Too kind." Zheng Ren smiled slightly and said modestly.

"Doing well is good; being too modest as a young person isn't." Director Zhang finished chuckling and began listening to Zhou Litao once again report the medical history.

The Inpatient Chief most dislikes this task—having to repeat the same medical history once or twice, sometimes even three or five times over.

Fortunately, several directors have arrived, so it seems no further reporting is needed.

Soon, after hearing the medical history, everyone began studying the images.

The patient's condition was poor; after the blow of two general-anesthesia surgeries, the body had just begun to recover after a week, but then a hepatic hernia appeared, and after enduring a long journey, they finally arrived at ward 912.

After such a ordeal, even an ironclad body would develop some issues.

For emergency surgery, should thoracic surgery or hepatobiliary surgery perform the operation? That is the question.

No one wants to take on a patient who's been butchered, so the experienced Cui Lao directly summoned the heads of the two relevant departments to his office to avoid them passing the buck.

Of course, the Emergency Department has the authority to send the patient directly to a department, and that department cannot refuse. But sitting together, speaking clearly, and then going up to operate as a team is the better choice.

Handling this with such maturity is something only an academician-level elder can muster, calling in the senior heads of the two related departments and the Emergency Department director for a joint consultation all at once.

Zheng Ren had originally planned to just loaf around.

The patient's condition is fairly clear: operate, explore thoroughly, and repair the diaphragm. For such a matter, I can't say which director should take it.

Anyway, with Cui Lao around, I can slack off one moment and enjoy myself the next.

But his clever plans were quickly shattered, as several directors remained silent, staring at Zheng Ren.

"Little Zheng, share your thoughts," Cui Lao said slowly.

"... \" Zheng Ren, puzzled, looked left and right; seeing that the two senior directors weren't speaking, he knew he had to say something.

Partly because Cui Lao valued him, and also because the recent Ge Xie Disease surgery had earned Director Zhang's appreciation.

If it were someone else, this would be an honor, but Zheng Ren knows how deep the waters run and finds it difficult.

Zheng Ren frowned slightly, and Cui Lao's gaze felt like a whip lashing at him.

"Let me throw out a brick to draw a jade; I'll briefly share my view." Zheng Ren pondered, then spoke politely, "If there's anything unexpected, please direct me, directors."

"The patient, due to congenital retrosternal diaphragmatic hernia combined with older age, has led to atrophy of the right diaphragm."

Moreover, because the original hernia was too large and the disease course long, postoperative diaphragm dysfunction occurred, and intraoperatively resecting the entire hernia sac further weakened diaphragm function and possibly damaged surrounding tissue.

"In summary, I believe the patient's hepatic hernia results from the resection of the congenital retrosternal diaphragmatic hernia sac, causing excessive diaphragmatic tension, combined with pulmonary bullae and high mechanical ventilation tension, pulling and causing extensive tearing of the right diaphragm."

"For surgical repair, it's best to use a patch to relieve local tension. Do we have such patches in our hospital?" Zheng Ren asked.

"Hmm." Director Zhang nodded and said, "The tear is about 15 cm long; I agree with Zheng Lao Ban's analysis. If approached via the abdomen, the liver would obstruct the field, making it difficult, so I recommend thoracic surgery open-chest treatment, and we can assist."

Thoracotomy has long been the most common invasive approach for hernia repair, especially suitable for removing the hernia sac. Postoperative morbidity and mortality from laparotomy are considered the highest, and Director Zhang's statement is correct.

But Zheng Ren hesitated slightly, then remained silent.

"Little Zheng, what do you want to say?" Cui Lao, though wearing reading glasses, perceived everything keenly.

"I think Director Zhang is right; the key to the patient's surgery lies in the patch." Zheng Ren said, "The patient's diaphragm likely atrophied, so removing the hernia sac raises tension, causing tearing. The patch itself is more resilient than the diaphragm and can fully relieve its tension."

"A patch that large makes surgery difficult," Director Li of Thoracic Surgery mused.