surgery

Luke's surgery took about 5 hours. The surgeon started out intending to do it all laproscopically and then with a robot but God hasd other plans. Luke had a lot of scar tissue that took hours to separate his stomach from his liver and to undo the old fundoplication. Finally it was decided to open up his belly (about an 8inch incision). Though this seemed like a setback (more pain, longer recovery) I believe it was God's hands directing the surgeon. They continued to peel away the scar tissue even having to take a small piece of liver off and allow it to remain attached to the stostomach. He didn't have a lot of bleeding and eventually it was time to move onto redoing his fundoplication. Luke did have a hiatal hernia which probably made thing worse and allowed the reflux to get so bad this summer. That was repaired and the fundofundoplication was wrapped and sutures. He did not have a lot of scar tissue on his intestines which was surprising, but good. His spleen was found to be of normal size but rock hard (not sure Sat that is about.. Will be asking his transplant team their thoughts). The surgeon did a full thickness bowel biopsy as we have been wanting that to see if it gives us any clues to the bad belly. No scar tissue was found to seem to case bad belly issues until at the very end in the left lower back corner of his abdomincal cavity the surgical fellow found three very thick bands of scar tissue by his large intestine. That is why I feel it was God's hands leading the surgeon to open up Luke's belly. They would have never found them I f he wasn't opened up. This may be the answer of his 15 episodes of obstruction/pseudoobstruction. It may have been trapping his intestines if they slide in between these three bands. His intestines may also be twisting off. The surgeon said this area if it wasn't the problem causing those would definitely cause issuesin the future. I am so thankful even after many hours they remained thorough and found this. So not only was his reflux stopped but maybe the bad belly answer was found!
When I spoke with the surgeon he felt Luke would be on the ventilatventilator all night because of the length of surgery. I packed up his things on 7A and went to the waiting room on the PICU floor and waited. Finally I was able to see Luke almost 9pm. And to my surprise he was only using face mask oxygen. I am so incredibly thankful for his gift of new lungs. I can't imagine his old lungs being able to tollerate this... But his new lungs have made him able to do well in these situations. He is definitely working hard to breathe.. He looks like his breathing before transplant. His chest Cray doesn't look great and he isn't breathing real well. It was talked about putting him on BiPAP like he was on before transplant but I am guessing surgery didn't want all that air going in his belly. So for now he is on high flow oxygen . His numbers look ok but he continues to work.
thankfully the pain team got involved from the start and placed an epidural before he left the OR. It makes a huge difference in Luke's pain control. He also has a PCA where he can push the button to give him does of pain medicine. He
has been sleeping fairly well but he has to be sitting upright for his breathing.
He is very unhappy with all the tubes .. tube down his nose into his stomach ddrining his belly, catheter draining his urine, extra I Vs, arterial IV line, and oxygen. I don't blame him. We are in a nice size PICU room . I love that parents are always encouraged to stay with heir children and they have almost all the same accommodations as when I stay on the floor with him (fold out sofa bed, bathroom just no shower here, outlets, tables, etc). He won't be able to have anything in his stomach at least 2 days. He will have a dye study where they put dye in his stomach and take drags to make sure there are no holes or problems.
For now he isn't peering as much as they would like, his potassium is high, he has a lot of really horrible looking stuff coming from his gtube (feeding tube) as well as his by (tube in the nose to the stomach) and jtube (the tube he has that goes to his intestine we put his meds in). I'm sure it will take a while to get his intestines to wake up. He is being kept on antiantibiitics to prevent infection. I am guessing he will be in the PICU tonight and hopefully go back to his floor tomorrow.
I am so thankful for an amazing medical team and hospital to care for Luke. I am so thankful for the Ronald McDonald house where my mom and the girls are staying. Glen and the boys are coming out totoday. I am so thankful for the Family life programs here. This week they have a fall festival, the parents coffeehouse (with live music, coffee, desserts) for the parents on Friday night, sibshops (a special program for siblings ) on Saturday , after school programs twice a week, the library for the kids, child life, and  the school program.
Please keep praying for healing, no complications and his comfort. Please also pray for the rest of the Family as the stress of this added to everyday stuff (because after all life goes on.. bills need to be paid, work hours have to be put in , school has to be done, house chores have to be completed, etc) can be hard. Thank you for all the prayers yesterday. We praise God for his guidi.g hands and all the miracles Luke has had. And as always we thank his do not family for making the  decision to give Luke life and his new lungs which continue to be awesome.

Luke this AM

Luke right after surgery last night.

Getting drags late at night in his PICU room.

As I waited to see him I looked at the miracle he is through his Beads of Courage.

About to role into surgery

the Carnegie Museum of Natural History  comes and does science programs at the bedside for the kids. Today's was about the Arctic. Luke enjoyed it and it made the time pass quicker waiting for surgery.