Details of surgery to repair fistula in my liver
Just thought I would post to let everyone know that things went well with the surgery to plug the hole (fistula) in my liver. I had the operation last Monday (March 31st) in the afternoon and was sent home via adapted transport early evening on Wednesday. When they told me they were sending me home so soon I was kinda freaked out because I was having constant liver pain, still had residual bloody stools, and was experiencing fatigue and exhaustion 10-20 times sooner than before (and that was already way too soon for comfort). But a little reassurance from my doctor that the bleed shouldn’t reoccur and I was ready to come home … just being in the hospital was driving me crazy. All those sick and annoying people screaming all day long. lol.
Anyway here’s what happened …
First of all, I was freaking big time the 2-3 days before the surgery. Wasn’t just the huge uncertainty of the outcome and the scary-sounding procedure either. I was in serious pain and distress. I had experienced 5+ of those painful and debilitating episodes I discussed before within about 18 hours (instead of 5 over the month before). I was literally in bed unable to move or even really breath for hours at a time. Was receiving a lot of morphine via pills, sub-cutaneous injection, and IV … as the need required. I guess my liver had just decided that enough was enough and decided to have a fit. Anyway, it was rough to say the least … but I toughed it out because I knew that the best doctors where only available on Monday and didn’t want to risk another botched surgery by relying on whoever was on call in the Angiography/radiology department. Luckily, my sister called me the morning before the surgery and sensing my distress decided to take the afternoon off and spend some time with me before the operation. Things had calmed down in my liver during the day … so I was ready to go when the porter came to pick me up around 3pm.
The procedure took place in the Angiography department of the Royal Victoria hospital in Montreal. A much larger and more sophisticated room than where I underwent the previous 3 biopsies (technically in the radiology department i guess). Immediately on arrival I instructed them that I would need additional pain killers for my back so that I could remain still during the ordeal as I still cannot stand lying flat for more than a half hour at a time, especially on an inadequately-padded operation table. It was no problem for them and they gave me some IV pain killer along with the oxygen (and possibly some conscience sedation gas) through the nose. I was feeling fine. Reassured by the presence of 2 doctors, 2 nurses, and a technologist in the room. They briefly told me what they were going to do, and I was surprised and relieved that they were going in via the femoral artery in the right groin area. Much preferable than the transjugular entry that I was expecting and dreading because of the breathing and pain involved. The incision and entry into the femoral artery was painless and easy, so good. They repeatedly injected a contrast agent and took xrays from different angles to get a good view of where the bleed was. Then they went in with a coil … a 4mm diamond shaped one (out of a selection of 3 different shapes ranging in length from 2 to 8mm). They had told me that the coil had clotting properties and would seal the bleed and plug off a branch of my hepatic artery. From the sensation, I assume they applies a small current to the coil and that is what does the sealing. I think they did this 2-3 times in slightly different places very close to one another, each time for just a few seconds. They injected more dye and took more xrays. The doctor and nurses took a bit of time to confer over the images to assure that they had fixed the problem and no other fistulas were present elsewhere. (I’ll be making another post soon, describing exactly where and how the fistula formed and how it was fixed - with a diagram. so stay tuned.) That was it, operation over. They just had to pull out the catheter and seal up the hole. This was the most painful part of the procedure, but really relative to a biopsy and especially relative to the pain I had been in for the past days and months … it was nothing. A little more than some extreme pressure and what felt like 3-4 intense pinches to seal up the opening. I thought that perhaps they had put some staples in or something, but I guess not.
So the good news of it all came when they were done. They were able to get in deeper and closer to the source of the bleed than they had expected. They sealed off a branch of a branch off the hepatic artery. YAY. that is awesome. I’m not sure of the reality of how much of my liver will be deprived of blood and eventually die off. But from the sounds of that, it will be much less than the 1/3 that I was expecting and prepared for going into the operation. I guess the proof of how much I lost will never be determined exactly, only guessed at based on how quickly my liver enzymes go down and how well my liver function tests look in the weeks and months following this whole ordeal. I’m still a bit scared and worried about that … I’m feeling quite subdued and lacking energy and endurance at a level I never have before. But a lot of that is attributed to the liver adjusting to it’s new circulation patterns and just the trauma from the surgery and preceding months of bleeding, pain, and medical tests. It was gruelling and exhausting to say the least.
So, anyway. After the procedure was done and I was waiting in the hallway, the clock read somewhere around 6pm … so the whole thing, including getting me on and off the table, took about 3 hours. Getting off the table was not easy!!! Besides my back problems, I was not allowed to turn on my side or bend my right leg, waist, or neck for 3 hours following the operation! Any of these movements causes an contraction of the abdominal muscles and could cause the clot and closure on the femoral artery to release. That would not be good! The femoral artery is the bodies largest artery and I was told that I could bleed to death within about 2 minutes if this happened! So ya, I stayed pretty still … not just for the 3 hours, but more like 12 … just to be sure!. Lol. The only movement I really made on my own was right after I was back in my room … slowly reaching behind my head for the phone and blindly dialling my sister to let he know that it went well and that I was doing fine. Made sure to let her know that I didn’t want anyone to call as it was too hard to answer the phone. During the first 4 hours I must have drove my nurses mad, as I had to have them come in and apply pressure to the area anytime I needed to adjust in the bed, or even take a sip of water! Oh ya, the nurses. I was very grateful for all of their help that week at the RVH - very good people there. And as ‘luck’ would have it, I had 3 of the best nurses in the Short Stay Unit (a subsidiary of the ER, where I was staying). Awkwardly, the 3 nurses i had just prior and after the surgery were all male. lol. Don’t get me wrong, I actually prefer the male nurses usually. I find them very methodical and thorough. They don’t mess around at all, and that’s how I like it. Female nurses are good also (and nicer to look at!) but they waste a lot of time trying to be ‘nice’ and make you feel better. Differences in the nature of the sexes I guess. So ya, I have to apply pressure to by groin and change bandages a few times a day, and all I have are male nurses. Needless to say, I’m not used to people poking around down there, but even less so by guys! I’m sure it’s nothing either of us looked forward too, but I’m not sure it would have been any different with female nurses … just a bit more pleasant perhaps, though probably good thing it wasn’t. lol.
The following 2 days were difficult. I was having a really hard time moving around. Having to lie down and take breaks between even the simplest of tasks, like eating or going to the washroom. I even broke a sweat just sitting up in bed to eat lunch! crazy. I did manage to take a shower Tuesday afternoon, that was very very tiring and scary … even sitting down most of the time in the shower room. But it felt good to be clean at least. I just had to rest afterwards for a few hours. Same for Wednesday. Late Wednesday morning I was informed that I could go home that day. I was surprised and shocked. I had been told previously that I would be there for observation for 4-5 days after the procedure, not 2. It took a lot of convincing from the floor doctor, my liver specialist’s resident, and finally my specialist himself to reassure me that I was indeed ok to return home. It’s kind of crazy if you think about it. If someone called up a doctor and said that they had constant and severe liver pain, black stools, and were experiencing exhaustion at 10-20 times their normal (and already low) levels … well, they would tell them to go immediately to the ER because their life is in immediate jeopardy!!! But for me, this is the condition at which it is OK to return home! Now that really boggles the mind!
