Fistula surgery

The fistula is GONE!!  It took thirteen hours in surgery, but it is finally gone!

The intestine which was connected to it was bad tissue.  It was leaking chyle and had no necessary function since it was taken out of the GI tract in March.  It was continuing to cause sodium imbalances and limited his ability to feed since it seemed to go up in excretion volume as we would increase his feeds.  Ultimately, there was no way to continue to increase feeds and get off TPN without removing that intestinal tissue.

Peter was called to surgery at 6:30 am and taken back into the OR at 7:30 am.  At 9:15 the first incision was made.  There had been a lot of prep work to do before making the incision, but he was already getting sedated at 7:30 am.  At about 2:30, Dr. Jennings and Dr. Kamin met with us and Dr. Jennings told us that he could continue to remove the intestinal tissue on the other side of the fistula and then close it, or just stop where he was and close up, knowing that the main source of trouble had been taken out, but with the chance that we could still see problems with that portion of fistula and tissue that was still left.  We all agreed that it seemed a good idea to continue while he was doing so well.  Dr. Jennings said he was up for continuing the surgery another six to eight hours. 

At 8:30 pm, Dr. Jennings came to say that the surgery was finished and Peter's fistula is gone.  Peter's abdominal muscles have been moved almost all the way back to midline.  (They have been off to his sides since July 2006, when he had abdominal compartment syndrome and the abdominal incision had been left open to heal without being sutured back together.)  He lost a liter of blood, which was not much considering he has portal hypertension.  Dr. Jennings said his liver looks pretty healthy in color, no nodules and is firm but not hard.  We can thank Omegaven for that! 

Peter has a ways to go to recover from such a big surgery, but so far he is doing well.  We still can't believe that the fistula is actually gone.  This should have big potential for his overall recovery to a life without TPN, and for his physical ability too now that his muscles are so much closer to the correct place they should be.