Date With a Surgeon

This morning we had our second post-NICU appointment with Dr Adamson. Daren and I went into the appointment with lots of questions. The million dollar question - when are you going to try and do surgery????

Prior to seeing Dr A, Willa had to be weighed and measured for length. Willa gained a few ounces from last week Monday. She is up to 6 pounds and 7 ounces.  Her length is still just shy of 19 inches.

Visits to Dr A means being almost naked for Willa. This is the one chance the omphalocele has to breathe. Daren and I have our dressing changing sessions down to less than two minutes. This morning,  clad only in a droopy diaper, Willa got to squirm around for about 10 minutes. She was a happy little girl. Dr A is very pleased with the looks of the om. He even mentioned letting it get some air once a week would be good for it.  I was shocked when Dr A started compressing portions of the om back into the abdominal cavity. It didn't phase Willa a bit. Dr A said he didn't feel the liver with in the om and believes most if not all of it has gone back inside.

Our questions...

#1 What is the timetable for the surgery?

Although there is still no definite time scheduled for the surgery, Dr A was very pleased with the progress and shrinkage of the om. While not willing to commit to a date, he was optimistic that it would be on the near end of the 6-12 month window, maybe even a little before it. It could be as early as 4 months if the om continues to retreat inside as well as it has so far.

#2 What is Willa's recovery time post surgery?

We were originally thinking that the recovery time for Willa would be around a month, as a result of some information in the abdominal defect DVD that we previewed for UNC. While this is generally true for an om of this size, if the om continues to shrink at its current rate (see #1), there won't be much "extra" work to do to repair it. Additionally, since it will have mostly migrated inside on its own, the lungs won't be as disturbed as if the repair had to push organs back inside, which could squeeze the lungs and impact breathing. Willa's recovery time would likely be more on the order of a week or two.

#3 Do the organs just "fall into place"?

A friend asked, "After surgery, will the appendix be where the appendix is supposed to be?" The quick answer to this is, mostly. It seems that the liver really doesn't care where it lives. Likewise, the intestines can float around to some degree. The appendix could be on the right side instead of the left side. Generally, all of this is ok. As Dr A mentioned, it might be worth noting where things end up in case there are ever any issues (not even necessarily related) in the future and people go looking for things in normal places. One of the few potential problematic scenarios would be a twisting of the intestines as things fall back into place, but that is more likely for a gastroschisis than om.

#4 Will you use a natural or artificial mesh to close?

If the mesh were non-natural, or not of a type of material that would be absorbed by Willa's tissue, there would need to be a second surgery to remove that mesh. Even in the event of a natural mesh, there would likely be a hernia that would need to be repaired.

However, much to our pleasant surprise, Dr A is currently planning to let things continue to progress with the om retreat in the hope that no mesh at all will be required. By waiting for things to settle inside over time and stretch out the area required to contain them in the process, the plan would be to simply use existing muscle and tissue to close her up. That would mean no second surgery at all!

After our Q&A session, Dr A mentioned some slight concern with Willa's slow weight gain. She should be gaining 1/2 ounce to 1 ounce a day. After a visit from a nutritionist, we'll add a bit of formula to the breast milk when bottle feeding. That will take Willa's calorie intake from 20 calories per ounce for plain breast milk up to 24 calories per ounce.

The day ended at the prosthetics and orthopedics end of the hospital. Some additional padding needed to be added to the shell to account for the smaller size of the om. The adjustment was quickly made and Willa was strapped back in to her new and improved device!