My Medical Skills Give Me Experience Points Chapter 1401 - 557: Destruction Is Not Injury, the Comforting Anesthesiologist

With a thorough understanding of the patient's gastric situation, Zhou Can gained more confidence.

"Could you please display the patient's pre-operative esophageal imagery once more?" he requested.

He intended to leverage the endoscopy procedure to pinpoint the exact location of the esophageal fistula and, if possible, determine the root cause of its formation. This would be crucial to prevent recurrence after a subsequent surgery.

"Here is the latest esophageal imaging for the patient. The fistula opening is more than 1cm!" Director Tan uttered these words with a hint of shame.

The original esophageal rupture measured approximately 6cm, and now with a fistula opening exceeding 1cm, it was becoming difficult for him, as the lead surgeon, to avoid a degree of accountability.

As Zhou Can carefully maneuvered the endoscope for withdrawal, he meticulously searched for the fistula's location as depicted in the imaging. It took considerable effort before he finally pinpointed it.

Viewed from the interior of the esophageal wall, the fistula was not particularly conspicuous.

This particular site was situated at the base of the prior suture tear, with some signs of infection potentially causing the sutures to give way.

Relying on his surgical expertise and his Level 6 Suturing Skill, after a thorough examination, Zhou Can ascertained that the other portions of the esophageal tear had initially healed well. This was a positive development.

Consequently, there was no necessity to interfere with those areas again.

To address this fistula, debridement followed by a fresh suturing would undoubtedly be required.

However, there was no assurance that after re-suturing, reinfection or suture dehiscence wouldn't occur again.

In reality, once the esophageal wall becomes infected, even if it doesn't develop into an abscess, the sutures are prone to tearing open once more.

Even under the most optimistic scenario, where Zhou Can, utilizing his Level 6 Wound Cleaning Skill and Level 6 Suturing Skill, successfully repaired the fistula and it healed without re-opening, the long-term impact on the patient would still be significant.

What kind of impact, specifically?

The patient's esophagus had already become hardened and brittle, with notably diminished elasticity and resilience. This meant that the maximum size of food particles that could pass through was considerably smaller than usual.

Furthermore, a few days prior, a 6cm tear in the esophagus was sutured, leading to a substantial reduction in the internal diameter of that specific esophageal segment.

Zhou Can had personally felt this during the recent endoscopy.

The repaired section of the esophagus was perceptibly narrower.

This condition would invariably affect the patient's ability to eat post-surgery, making them highly susceptible to choking.

If additional debridement and re-suturing were to be performed on this already narrowed area, the passage within the esophagus would become even more restricted.

Following such a procedure, the patient might be limited to consuming only liquids.

And not just any liquids, but very thin ones; anything thicker would immediately cause an obstruction in the esophagus.

Plans are indeed subject to frequent changes!

Conducting this endoscopy was indeed a highly necessary step.

Had the patient's condition not been thoroughly assessed and had thoracoscopic surgery been performed directly to address the esophageal fistula, even if the surgery itself was technically successful, it would undoubtedly be deemed a procedural failure in terms of patient outcome.

"I'm curious about the nature of the secondary surgery your hospital had planned for the patient?" Zhou Can inquired of Director Tan and Song Qian.

It was essential to first ascertain the perspectives of the primary medical team.

"We invited Dr. Zhou here specifically to help rectify the situation, so naturally, we will defer to Dr. Zhou's professional judgment," Song Qian responded on behalf of Director Tan.

"Given that the fistula opening is not extensive, it would be ideal if it could be repaired in conjunction with the existing surgical site. Prior to Dr. Zhou's arrival, the surgical plan proposed was to address it via thoracoscopic surgery. This approach results in less trauma for the patient and is considered minimally invasive, a method I fully endorse," stated Director Tan.

Tan Shengli appeared to possess a rather traditional and cautious surgical philosophy.

This particular approach to surgery favored a methodical, step-by-step strategy when formulating operational plans.

While this method offered the advantage of stability, its drawback lay in its lack of adaptability, exhibiting a considerable degree of rigidity.

"Before I came, I had indeed considered performing thoracoscopic surgery to directly repair the esophageal fistula. However, during the endoscopy I just completed, I identified a complication: the esophageal fistula has formed within the segment of the previous rupture. If a secondary suturing is undertaken, I am concerned it will significantly compromise the patient's quality of life post-operation. Therefore, I am leaning towards an alternative approach."

Zhou Can's Level 6 Pathological Diagnosis skill proved invaluable in formulating a more optimal surgical strategy.

"Is there indeed another solution?"

Director Tan's eyes brightened slightly, while Song Qian's beautiful gaze sparkled with keen interest.

"With the patient currently suffering from an esophageal fistula, ensuring adequate nutritional support has become a critical concern. Without sufficient nutrition, the wound will struggle to heal, and the body could face numerous complications. Should that happen, his condition will grow exceedingly perilous."

Zhou Can elaborated on the core issues for everyone present.

At this moment, the patient experiences immediate leakage upon consuming anything, with only a meager amount of food successfully reaching the stomach. Any food that escapes via the esophageal fistula makes its way into the thoracic cavity. Despite the placement of a chest drain during the operation, a significant safety risk persists within the thoracic cavity.

Should an infection take hold in the thoracic cavity, even the most potent antibiotics might prove insufficient to save his life.

"Dr. Zhou, may I interject and inquire about your assessment of the contributing factors to the patient's esophageal fistula?" Tan Shengli, after absorbing the information, seemed to have a breakthrough in his surgical reasoning and interrupted Zhou Can.

"During the recent endoscopy, I observed ulcers within the esophagus, accompanied by redness and swelling. My hypothesis is that the esophageal wall's edema and inflammatory necrosis were the culprits behind the esophageal repair's failure, causing the sutures to rupture and resulting in a non-healing wound."

Zhou Can felt compelled to state the facts.

This predicament arises occasionally and is somewhat linked to the surgical proficiency of the operating physician. For instance, managing post-operative edema could be addressed with proactive measures if such a scenario unfolded at Tuya Hospital.

"Very well, please proceed with your proposed treatment plan!"