Trip to the Operating Room

Yesterday, on Lincoln's third week birthday, he made a trip to the OR for his diaphragm repair surgery around 12:30pm. (The OR was busy so his surgery was pushed back to the afternoon.) All of his equipment went with him, including his ventilator, oxygen and nitric oxide tanks, his bed with him in it, monitors for his vitals, and all of his tower of IV pumps. It took the coordination of about seven doctors, nurses and respiratory therapists to get everything out of his room, down the hall, in the elevators, up to the 6th floor, and out to the OR. They all did a great job moving Lincoln. His heart rate never even went up. Dan and I were allowed to follow and ride up in the elevator with Lincoln and the whole team. We gave Lincoln a kiss just before he went back to the OR and Dan and I went to the waiting area.

While Dan and I waited, the nurse in the OR called several times to give us updates on how things were going. At 5:00pm, Lincoln's diaphragm repair surgery was complete. The surgeon came out to talk to us, and told us that everything went fine and Lincoln was doing well. His hernia was 5 cm big, with the midline of his diaphragm intact and some diaphragm in the front and back on his right side. Almost his entire small intestine, some of his large intestine, and most of his liver were herniated into his chest. She did not have to use any patches to close the whole in Linc's diaphragm, or to close the incision site. She said it was a tight squeeze, but she avoided using patches to reduce the risk of infection. There is a risk of hernia recurrence whether or not a patch is used. With Linc's hernia being on the right side, his liver sits right under the closure, acting as an additional barrier between his chest and abdomen. If Linc does have a recurrence, we may never know due to his liver position, which is good. The whole idea is to keep the bowel out of the chest.

They are keeping Lincoln paralyzed for at least 24 hours so that he does not pull any sutures or strain his super tight diaphragm. He is, of course, heavily sedated and has plenty of pain medicine to help him during the healing process. The doctors will be watching his urine output as an indicator if his abdomen is too tight. If his kidneys are being squished, they will not produce enough urine, and that is an indication that everything is squished. In that case, they can open his incision again and put a temporary patch on his abdomen to allow more room for a few days until his skin stretches. Hopefully he won't need that though. They also are watching his edema. Sometimes the empty space newly created in the right side of his chest can fill with fluid before his lung expands. So for now, they are letting his rest and allowing the ventilator to do all of his breathing. His settings were turned back up after the surgery to 100% oxygen, and so far he is oxygenating very well. The next steps are to heal from surgery, then start to wean some of his support. Hopefully, Lincoln heals quickly without complications and is accepting of his weans. Who knows, we may be able to hold him in a few weeks.