Enhanced recovery after emergency laparotomy
18 May 2023
7 July 2022
“Surgery saves lives”; this was the very first hypothesis that I used to contemplate, when I decided to become a surgeon. As a young, passionate surgical intern, life could be challenging with long hours of duty, physical tiredness and mental burnout, a vast load of patients and little time spent with family and loved ones. I kept going because “Surgery saves lives”.
He came in a cold night early in March of my third year. Only 30 years old with all of his small intestines wrapped around a tiny adhesion band, cutting off the blood supply. We had to resect most of it. Next to the second-look operation, and 5-6 operations afterwards, to make sure his body could heal the anastomosis after several failures due to malnutrition.
He survived with only 20 cm of jejunum. I used to visit him often. Initially, I watched as he died little by little every single day, with constant diarrhea resistant to any treatment, and devastating loss of weight and energy despite a long list of supplements. Surgery was supposed to save lives!
I knew that I did all that I could at that on call night, from operating on him to providing proper postoperative care; and yet deep down, strangely I felt like I had to apologize for what I had done, at every visit.
It took me time to realize we are not in a position to know what “rescue” exactly means for everyone. We are only here to do our best, with good intentions and ever-evolving knowledge and skills. It is a truly precious gift to play even a small role in someone’s life, to help as much as possible, and to leave your footprints in their journey… After months of recovery in ICU, and with only 20 cm of jejunum, he survived.
I called him months later after he discharged well-conditioned. The diarrhea gets better and better and he is doing well even with 20 cm of jejunum. Here is the answer I have been looking for; “It was worth it!”
Figure 1. First operation in March 2021. The whole small intestine from 20 cm of Treitz ligament to the hepatic flexure of colon was gangrenous:
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