Home from Surgery
I asked what time it was when I woke up from surgery. It was mid-afternoon. The surgery must had only taken a few hours. No, it was mid-afternoon of the next day. The surgery took 11 hours and included an additional procedure, a “repair pseudoaneurysm”, in addition to the retroperitoneal lymph node dissection. The cancerous tumors had damaged the artery walls of my aorta when they were both growing and shrinking. The aorta wall would not hold a surgical suture, so it was repaired with a Dacron tube graft by a vascular surgeon.
The repair is similar to an Abdominal Aortic Aneurysm (AAA) open repair. Here is a good image from Stanford Healthcare’s AAA page:
Vascular Surgeon Notes
Here are the vascular surgeon’s transcribed notes:
DATE OF PROCEDURE: 03/08/2021
PREOPERATIVE DIAGNOSIS: Ruptured aortic pseudoaneurysm.
POSTOPERATIVE DIAGNOSIS: Ruptured aortic pseudoaneurysm.
PROCEDURE PERFORMED: Open repair of infrarenal aorta utilizing 11 mm Dacron tube graft.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 400–500 mL
COMPLICATIONS: None.
INDICATIONS FOR PROCEDURE: I was called for an intraoperative consult for bleeding from the aorta. Mr. Taggart is a 41-year-old male who was undergoing open retroperitoneal lymph node dissection. The tumor was adjacent to the wall of the infrarenal aorta and bleeding from this area was noted.
DESCRIPTION OF PROCEDURE: The aorta was already exposed. The right and left wall of the infrarenal aorta superiorly was exposed and the aorta was cross-clamped. Both bilateral common iliac arteries were identified and they were further dissected using cautery and Metzenbaum scissors, then clamped. The infrarenal aorta was inspected. There was some lumbar bleeding, which were oversewn using Gore-Tex suture and clips. The wall of the infrarenal aorta at the iliac bifurcation was directly adjacent to the tumor and appeared weakened and was very friable.
The aorta was opened longitudinally using Potts scissors and transected superiorly and inferiorly for a 3–4 cm segment. A graft sizer was used to select the aorta-aortic prosthesis. An 11 mm Gelsoft graft was selected. This was prepared in standard manner. The end was beveled and anastomosed in an end-to-end fashion proximally using CV5 running Gore-Tex suture. The suture line was tested by flushing through the distal end of the graft with heparinized saline.
Next, the distal end of the graft was beveled and anastomosed in an end-to-end fashion onto the distal aorta using CV5 running Gore-Tex suture. Prior to completion of the suture line, the area was forward and backbled and flushed with heparinized saline to remove any air or debris. The suture line was then completed and in communication with anesthesia, occluding clamps were released, and flow was reestablished down the legs. On palpation, there was still absent flow in the left common iliac artery.
At this point, I elected to perform a patch angioplasty on the left common iliac artery. The patient was heparinized and the aorta and iliac vessels were reclamped. A longitudinal incision was made extending through the distal anastomosis of prosthetic graft and in the lumen of the left common iliac artery. The suture line was reinforced using a figure-of-eight 5–0 Gore-Tex suture on the medial and lateral wall.
Next, a bovine pericardial patch was brought on the field. This was cut to the appropriate length and beveled in each end and a patch angioplasty of the anterior wall was carried out using CV5 running Gore-Tex suture times 2. prior to completion of suture line, the area was again forward and backbled and flushed with heparinized saline to remove any air or debris. Suture line was then completed and flow was reestablished to down both legs in communication with anesthesia. Additionally, there was a focal area in the aortic tear superiorly and this was oversewn using running CV3 Gore-Tex suture. The aorta was then inspected and hemostasis was achieved. The proximal and distal anastomoses were reinforced with a ring of Dacron graft and FloSeal. The area was irrigated with antibiotic irrigation. The feet were then inspected and he had dopplerable posterior tibial and dorsalis pedis signals bilaterally. With this, the remainder of the procedure was performed by Dr L.
Leaving the Hospital
I was able to leave the hospital on Monday, 7 days after my surgery. Each day in the hospital was difficult. After attempting to drink some liquids on Wednesday, I had major vomiting. I wasn’t allowed to eat or drink again until Friday. I graduated to general food on Saturday afternoon. I had the last tube pulled out of me on Monday morning, not long before I left with my new walker. It felt really good walking out of the hospital.
Recovery at Home
I’m on a combination of prescribed pain killers (oxycodone 5 mg tablets) and laxatives (PEG 3350). My abdomen is swollen and it looks like I’m several months pregnant. Today, 11 days after surgery is the first time I’ve had a normal appearing poop, which is a major celebration 💩. I’m not allowed to lift anything over 10 lbs for 5 weeks. Just going up and down stairs and on short walks with my walker is enough. For physical therapy, I have some breathing, muscle squeezing, and light massage exercises that I’m doing regularly. When I return to work on Monday, I must step away from my desk once an hour.
Next Steps
I meet with my doctors next week to go over the results and next steps. My surgeon said the tissue he removed appeared to be just scar tissue or necrosis ❤️, and not teratoma or malignant tissue. We hope the lab confirms this. If so, I may be cancer free in the abdomen. I have a small left-over tissue mass in my neck that we’ll probably have surgically removed soon as well.
