Surgery Godfather-Chapter 359 - 0340: Difficult Reconstruction

Chapter 359: Chapter 0340: Difficult Reconstruction

After Yu Shuilian’s stitches were removed, her liver and kidney function remained normal, thus successfully passing the dangerous period of organ dysfunction.

As such, the reconstruction surgery of the urethra and anus was put on the agenda, and it came time to hand in the homework that Yang Ping had assigned to everyone.

What Yang Ping planned by assigning them homework, each to design a reconstruction surgery plan, was to hope that the three of them could discuss it together.

Takahashi is a master of international trauma surgery, mastering the latest concepts and techniques, allowing Song Zimo and Xu Zhiliang to collide with Takahashi and create a spark of thought.

According to the discussion information in the group, the three actually had their own advantages. Takahashi had the richest clinical experience,

Song Zimo had the highest talent, regardless of cognition or practical ability, he was clearly above Takahashi and Xu Zhiliang. The difference between Song Zimo and Takahashi lay in clinical experience.

For Song Zimo, the experience Yang Ping shared with him was still theoretical, a theory that can’t be achieved from textbooks. Since the number of surgeries he performed wasn’t as many as Takahashi, his clinical experience was naturally not as good as Takahashi’s.

Xu Zhiliang’s cognitive ability wasn’t inferior to Takahashi’s. However, both in theoretical knowledge and clinical experience, he was far behind Takahashi, who, after all, had been studying this specialty for a long time and had been learning and exchanging ideas everywhere.

Unlike Song Zimo, Xu Zhiliang didn’t have the experience given to him by Yang Ping and only had the limited clinical experience obtained from his Ph.D. studies.

Xu Zhiliang had been a student of Beijing Medical University from undergraduate to doctoral degree. Among China’s billion-plus population, being able to admit to Beijing Medical University indicates a top student from among billions.

Takahashi is a top student among a hundred million Japanese people. From this selection ratio, Takahashi is merely a top student in a province-level in China.

Thus, it made sense that Xu Zhiliang’s intelligence level is not inferior to Takahashi’s.

However, the elite medical training route that Takahashi underwent widened the gap between him and Xu Zhiliang in terms of clinical and research capabilities, which was reasonable.

Xu Zhiliang, given the necessary grooming and enough time, it’s completely possible for him to surpass Takahashi, or at least that’s what Yang Ping believed.

He hoped that the two could learn from Takahashi’s broad international perspective from interacting with him, which was the most important thing.

In the meeting room, crowded with people; some sitting, some standing, all wearing clean white gowns, even the usually most sloppy ones tidied up their collars and buttons.

These people were doctors, graduate students, standardized training students, interns of Orthopedics, and young doctors from other departments, who took the time to attend this meeting.

Those who were sitting were generally from Orthopedics, and those surrounding them were usually from other surgical departments.

Many stools were moved around, but everyone stood up for fear of not seeing or hearing, as standing allowed a better view.

The rescue operation of Yu Shuilian had already caused a sensation throughout the hospital. Now that Orthopedics was planning to reconstruct her urethra and anus, everyone wanted to know how this surgery was going to be performed.

If the rectum is present, and only the anal sphincter is damaged, a general surgeon or plastic surgeon would have many methods to reconstruct the anus.

But reconstructing a functional anus from the end of the colon surpassed everyone’s knowledge. Everyone was very interested in what kind of cutting-edge new surgical procedure was involved.

Besides, a department that snatched patients from the hand of death, a department that could attract top international trauma surgeons, a department that kept creating miracles.

Each focus point was fascinating, several high-ranking doctors from Plastic Surgery, General Surgery, Urologic Surgery, and Colorectal Surgery came, with the mentality of attending an academic conference.

This discussion, although it was a department-level surgery discussion, in everyone’s eyes, there was no difference from an international academic conference.

Yang Ping was almost like a god at Sanbo Hospital, Song Zimo, a genius figure, and Takahashi, a top figure in international trauma surgery. This meeting was bound to be exciting.

White gowns neatly lined up, the silent conference hall, a medical discussion was serious and solemn, everyone carried a sense of reverence.

The first one to showcase the surgery plan was Takahashi. The arrangement was purposeful, as no one, other than Yang Ping, had as much surgical experience as him. He is a leading figure in international surgery today.

However, during their time in the Comprehensive Orthopedics department, everyone forgot about Takahashi’s original identity. They treated him as the ever respectful, “Little Takahashi”. Yang Ping wanted to bring him in to inspire everyone’s enthusiasm.

Takahashi adjusted his white gown, turned to look at Yang Ping, and with his permission, confidently approached the podium. It was only then that he rediscovered his real identity.

He had many times walked to the podium at international trauma surgery conferences, his head held high. However, those occasions could never compare to this one because today, sitting next to him was the man he regarded as a deity.

The surgical charts were already entered into the computer and up on the high-resolution screen; these were drawn by Takahashi over his lifetime.

The purpose? No other reason than to gain acceptance from his young mentor.

“Ladies and gentlemen, my name is Takahashi Fumiya, a specialising trainee in Comprehensive Orthopedics. You can call me ‘Little Takahashi’. I will be presenting my surgical plan for Yu Shuilian.”

“Modern surgery began with controlling blood-flow, pain and infection. Up until today, surgery has solved many pathological issues. Regardless of the operation, it can never escape these three concepts: removal, repair, reconstruction.”

“Removal, like the treatment for an inflamed appendix, discards the infected tissues or organs, leaving our body free of it. Repair includes the treatment of skin lacerations, fractures, torn tendons. We try patched it up, returning it as close to the original anatomy and functionality as possible. As for reconstruction, it is currently the highest level in the field of surgery. If an organ is damaged and its functioning compromised, we exhaust all means possible to create a facsimile that can replicate its functionality. Artificial joint replacement is one such example.”

“Today, my plan for Yu Shuilian is reconstructive surgery because her naturally occurring anus and urethra no longer exist. To restore her excretory functions and allow her to live a dignified life like normal people, we need to reconstruct an anus for her.”

“The ultimate aim of reconstructing an organ is to mimic its function. The patient in question requires two reconstructions: for the urethra and the anus. The reconstruction of the urethra needs to only achieve a passageway for the passing of urine. The muscle controlling urination, located in the bladder’s neck, hasn’t been damaged. Therefore, this is a routine plastic surgery. It is not difficult. I have numerous papers on this type of surgery published in Lancet. One of them is about a reconstruction that I have proposed.”

“The hardest part is the anal reconstruction. To reconstruct an anus that can control defecation, current medical technology requires a remaining rectum and a complete nerve pathway. Unfortunately, this patient’s anus, rectum, and sigmoid colon have all been removed. Our defecation reflex’s terminal receptors and pressure receptors are located in the rectum’s mucosa. The descending colon does not have these receptors. Therefore, lacking a terminal for the nerve reflex arch, reconstructing an anus that can control defecation under these circumstances is nearly impossible.”

“Despite advancements in artificial anus development today, the technology is still imperfect. The prolonged insertion of a sphincter bag, the repetitive movement of the bag, the inevitable inflammatory reaction due to constant tissue stimulation; high-pressure activity of the bag causes tissue corrosion, pain, infection, and wound dehiscence, just to name a few complications.”

“I have performed many instances of electrically stimulated graciloplasty or gluteoplasty for in-situ anal reconstruction. The liquid closure rate is over 95%, a high figure worldwide, but for such high positioning ectopic reconstruction, we lack experience.”

“For grafting, we discard muscles around the patient’s upper limb and shoulder joint because they are needed to perform an array of backup functions. Therefore, I prefer to use muscle from the waist region. She will not need her waist muscles to maintain an upright position and the muscle strength impairment will be kept to a minimum.”

“For creating the sphincter, we can opt for a free pectoralis minor muscle flap, which comes with the thoracoacromial artery and medial antebrachial cutaneous nerve. Make a hole in the center of this muscle flap and implant it onto the descending colon’s end. The blood vessels can merge with the colon’s nearby supplying blood vessels, and the nerves can merge with the remaining genital nerves, forming a muscular control nerve conduction pathway. However, I still don’t have an ideal solution for producing an urge to defecate.”

Explaining his surgery this way brought him back to the level of a master in trauma surgery. After finishing, he was met with a round of warm applause.

The surgical plan was designed based on Takahashi’s extensive experience in reconstructive surgery, suitable for Yu Shuilian’s current condition. The most significant problem at the moment is the inability to reconstruct the reflex for defecation.

His operation can end the inconvenience of Yu Shuilian having to excrete through the abdominal stoma, possibly employing a regular defecation strategy to solve the issue of fecal incontinence.

Takahashi’s surgical plan is a high-level reconstruction combination. To achieve a 95% success rate is indeed globally top-class.

Downstage, Xu Zhiliang could feel the gap between him and Takahashi. He completely lacks clinical experience in this aspect and is determined to work hard to catch up with him.

When it was Song Zimo’s turn, Takahashi had already comprehensively discussed the surgical plan. Many things overlapped, but he highlighted the different elements in his approach.

The second brother of Comprehensive Orthopedics, under the leadership of Yang Ping, has improved significantly. Despite not having as much surgical experience as Takahashi, he surpasses him in theoretical knowledge and surgical intuition.

If Song Zimo is considered the genius, then Xu Zhiliang would be the outstanding individual amongst regular people.

“For urethra reconstruction, I do not recommend the use of bladder wall because it can cause some damage to the bladder. I would suggest using blood vessels instead.”

Reconstruction of the urethra is not a problem because of the external sphincter of the bladder.”

This chapter is updated by freēwēbnovel.com.

The challenge lies in reconstructing a functioning anus.

If the damage is limited to the anal sphincter, there are many ways to rebuild the sphincter. However, due to the high degree of damage in this case with the anus, rectum, and sigmoid colon all being removed, the likelihood of reconstructive surgery being able to achieve a functioning anus is very low.