Path of Medicine With a System-Chapter 276: Difficult surgery

Zhang Fan finished putting on his surgical attire with the help of the operating room nurse and anesthesiologist.

“Doctor Zhang, is it too tight? Is this alright?” the operating room nurse gently asked him.

“This is fine, thank you,” Zhang Fan answered as he directly went up to the operating table.

As Zhang Fan was putting on his surgical attire, Director Zhao automatically moved over to the primary surgical assistant’s position. Vice Director Song, who was the primary surgical assistant, moved over to the secondary surgical assistant’s position. The secondary surgical assistant became the third surgical assistant. There was no need for anyone to say anything. Everyone knew their own position. Zhang Fan’s skill level was far too well known in Chasu City Hospital by now!

Old Yang’s intestines had many small holes poked into them by the metal bars, so they had been like a sieve. However, the teenaged girl’s intestines were filled with much larger holes. Zhang Fan furrowed his eyebrows when he stood at the primary surgeon’s position and saw the patient’s abdomen.

The other doctors had already prepared an excellent field of vision for the surgery. Since the girl was still young, her intestines were pink and tender! However, such tender intestines were now filled with holes everywhere. Zhang Fan did a swift count and found six major visible holes. There was also a portion of the small intestine that had almost been completely severed!

The intestines’ blood supply was shaped like a fan. The fan’s handle was located at the liver. Although blood vessels here were really abundant, damage which was too severe would still cause organ failure due to inability to receive blood.

Outside the operating room, the contractor boss had a blank expression which was similar to the teenaged girl’s mother’s. Both of them appeared expressionless and tense, although they were different types of tense. Still, both of them similarly hoped that the patients in the operating room could be saved successfully.

Chasu City’s traffic police started going crazy. City Leader Zhao became so angry that he even spat up blood. He ordered for roadblocks to be set up everywhere. The traffic police weren’t checking for driving under the influence of alcohol or expired driver’s licenses. Instead, the traffic police only checked motorcycles and electric scooters. The police then confiscated every single motorcycle and electric scooter that didn’t have proper licensing and registration!

Chasu City was a relatively small city in China. Like other small cities, families with cars were in the minority. Most people would get around using motorcycles or electric scooters. Originally, the traffic police simply turned a blind eye to this, but they no longer dared to ignore things now that City Leader Zhao had gotten angry to the point of spitting up blood.

The ordinary citizens received quite a blow from this incident. No matter if their motorcycles and electric scooters were used for street races or not, they were all confiscated if they lacked proper licensing and registration!

Meanwhile, Zhang Fan directly began the surgery even as he furrowed his eyebrows. Quite a while had already passed before the teenaged girl’s surgery began. The longer that things took, the greater the chance that she would be infected.

Due to modern antibiotics being prevalent everywhere, maybe ordinary people would think that infections weren’t a big deal. However, infections after surgery were truly a major complication. A less serious infection would delay the patient’s recovery after the surgery, while a more serious infection might cause other problems in the patient’s body or even be fatal.

“Director Zhao, we won’t be able to do regular surgical repairing for this patient!” Zhang Fan said as he continued to investigate the girl’s intestinal injuries. Just the visible injuries alone were already too severe for standard surgery to deal with.

“Okay, what’s your plan then?” Director Zhao could already guess.

“Directly sew the greater omentum onto the intestines, and use enteroanastomosis to fix the most important parts of the intestine,” Zhang Fan answered.

“With such large holes, even if we use the greater omentum to cover them, the intestine still might die!”

The problem had been identified as intestinal damage in this situation. The foundational principle of surgery was to treat the problem. However, surgery plans also needed to adapt to the specific situation. Since this surgery was taking place in the intestines, where the blood cycle was poor and germs were abundant, and also since intestinal pressure was rather high, performing intestinal repair or enteroanastomosis would easily result in an enterovesical fistula or abnormal abdominal cavity residue that would easily become infected and lead to other problems.

Not to mention, far too many portions of the patient’s intestines had serious damage. Of course Director Zhao would be afraid. If standard surgical methods were used to repair the patient’s intestines, it would still be likely that she would suddenly have an intestinal obstruction any time after the surgery.

“It’s fine!” Zhang Fan already established his surgery plan in his mind. This was why general surgery was so difficult. Many times, a surgery plan that had been discussed before the surgery began would become unusable. The surgeon would need to rapidly establish a new surgery plan after seeing what the situation was really like inside the patient!

In orthopedic surgery, it was much simpler to establish a surgery plan just from seeing the patient’s X-rays and CT scans. More skilled doctors wouldn’t even bring any unnecessary medical equipment. Orthopedic surgery was rather straightforward as the blood vessels and nerves usually weren’t involved. The bones were rather similar to pieces of wood. It would be fine to simply install metal plates along the broken portion of bone!

However, general surgery was far more difficult. There were organs on top of other organs. Some gases and liquids couldn’t be seen from outside the body even with detailed examinations. Maybe before a surgery began, the doctor would think that the appendix had a problem, but then the patient was opened up and the appendix was fine! What to do then? Hahaha.

Zhang Fan didn’t explain his surgery plan. There was no need to, as he was the primary surgeon, which meant that he had the right to decide. He had the skill level necessary to make Director Zhao willing to listen to him. Zhang Fan immediately began the surgery.

He started on the jejunum and began to perform enteroanastomosis. There was no need to cut off any portion of the intestine here. He began to gently sew up the intestine.

Zhang Fan’s movements were precise and accurate. He was also sewing with a tiny absorbable needle. He gently passed his needle through the patient’s intestines and gradually filled up the holes. His movements were really swift and beautiful. He connected the damaged portions as if they were two lovers kissing each other. Zhang Fan then sewed up the intestine so that the holes would be closed forever!

“Whoa!” Director Zhao inhaled a cold breath in surprise. “Doctor Zhang, will this really be alright? What will happen to your sutures when intestinal peristalsis occurs? What about gastric food retention? There will be an infection! If any digestive juice gathers here, the sutures will definitely fall apart!” Director Zhao had never even witnessed such a surgical technique before.

“There’s a chance that there will be gastric food retention, but intestinal obstruction definitely won’t occur. Enteroanastomosis will also cause less damage than cutting out the portions of the intestine that might die. She’s just a teenager. How will she have a normal life after this if she loses too much of her intestine?”

Director Zhao wanted to say more, but was unable to counter Zhang Fan with any evidence, as he didn’t even fully understand the surgical technique that Zhang Fan was using. He could only do his best to assist Zhang Fan in the surgery. Performing surgery wasn’t like having a business meeting where many different opinions were possible. In surgery, you could only either support the primary surgeon’s decision or object to it!

Zhang Fan had practiced performing surgery countless times in his System already. His techniques were truly exquisite. With the thread going through the needle holder, he swiftly worked all around the intestine. Zhang Fan made many enteroanastomosis connections in the patient’s small intestine as if he was putting together a rubber tube.

Requirements for intestinal suturing would be extremely high, especially since so many enteroanastomosis connections needed to be made. The surgeon couldn’t allow any damage to occur on the intestine’s insides while suturing, so the surgeon would need to turn the intestine inside-out while performing the sutures.

Although the small intestine’s digestive juice wasn’t as strong as stomach acid, it would still be highly corrosive. Any damage to the small intestine’s insides would likely cause chronic pain to the patient for the rest of their life, and as time went on, it would develop into an intestinal ulcer!

Director Zhao still at least understood most of what Zhang Fan was doing. Vice Director Song, on the other hand, was rather confused. Although Vice Director Song was able to see Zhang Fan’s every action quite clearly from his position where he held the surgical retractors, he couldn’t comprehend what Zhang Fan was doing. This was due to the difference in surgical skill level.

Zhang Fan’s technique was incredibly beautiful. When performing enteroanastomosis on the serosal layer of the jejunum or the pedicled seromuscular flap, the intestine would indeed become shorter overall, but transverse sutures could be used in order to prevent intestinal stenosis.

In order to aid the patient’s recovery and prevent damage after the intestinal repair surgery, Zhang Fan completely covered all the repaired portions with the greater omentum and did his best to sew using only the intestinal walls whenever possible. He performed duodenectomy antrum excision, and then repaired the jejunum’s pedicled seromuscular flap. He performed surgery extremely swiftly.

However, this was truly a major and difficult surgery. Time was passing slowly. More than four hours had now passed since Zhang Fan started performing surgery on the teenaged girl. Director Gao and the other doctors had already finished performing surgery on Old Yang at this time. They came over to tell Zhang Fan that they finished their surgery successfully, as well as to see if they needed to help him out.

Even one intestinal injury in this surgery would be a highly difficult enteroanastomosis surgery under the categorization of general surgery. The patient had a very high number of complex injuries, yet Zhang Fan didn’t hesitate at all. He was incredibly swift.

Normally, if a veteran attending physician could master even one enteroanastomosis technique and successfully perform it, that surgeon would be able to proudly boast about it for at least half a year.

However, not only was Zhang Fan capable of performing complex enteroanastomosis surgeries on so many different locations in different conditions, his handiwork was incredibly beautiful. Vice Director Song began to sweat as he watched Zhang Fan perform surgery. Vice Director Song felt that this was what a true genius was. Normally, it would take at least several decades for a regular doctor to master enteroanastomosis techniques through constant practicing. Yet, Zhang Fan was only a resident doctor who had joined Chasu City Hospital a year ago!

Four hours had already passed since Zhang Fan took over the surgery. The four hours then became six hours, then eight hours, and then 10 hours. Zhang Fan finally finished repairing the patient’s intestines at this time. He gently stretched his back as he had been standing at the operating table with back bent over for all this time. He couldn’t move too much, because his disinfected hands weren’t allowed to be raised over his shoulders or placed lower than his abdomen. Otherwise, his hands would count as having been contaminated!

“Doctor Zhang, would you like some glucose?” The operating room head nurse had also arrived to assist in this surgery. The operating room nurse had been switched out multiple times already over the 10 hours. The current anesthesiologist was already the third one to join the surgery as they also took turns in shifts. However, the surgeons working at the operating table hadn’t eaten anything at all in the past 10 hours. They hadn’t even dared to drink any glucose!

“I’ll pass for now! Maybe later.” Zhang Fan swallowed what little saliva he had remaining as he gently refused and shook his head. He didn’t dare to drink anything as there was still a long way to go before the surgery on the teenaged girl was finished!

He could still withstand his hunger, but thirst was far more difficult to deal with. Yet, no matter how hard it was to withstand thirst, Zhang Fan would only take a tiny sip of glucose and wet his lips and mouth slightly!

Vice Director Song could no longer even feel his legs due to how long he had been standing up. He glanced at the head nurse’s plastic glucose bottle, and asked, “Please feed me just a little. Don’t feed me too much, as I’m afraid that I won’t be able to resist going to the bathroom. Just feed me a little!”

Even a vice director was acting so pitifully as if he was a hungry child, looking with such desire towards the glucose which actually tasted rather bad.

Zhang Fan would absolutely have to finish this surgery from start to finish. Nobody could possibly replace him!

“Director Zhao, Vice Director Song, how about the two of you get some rest, and ask some other doctors to replace you? I’m younger and have better stamina, after all,” Zhang Fan remarked to the directors because he saw how pitiful Vice Director Song looked.

“No! We’re not even close to finished yet! I’m still fine,” Director Zhao adamantly insisted.

“I’m fine as well. I’m just a little thirsty. This is probably the only time in my life that I’ll ever meet with such a complex surgery. I’ll absolutely regret it if I don’t persist until the end! Come, Director Zhang, continue the surgery!” Vice Director Song said respectfully to Zhang Fan after he moistened his lips. If Zhang Fan completed this surgery successfully, he would truly have suppressed and conquered the entire general surgery department of Chasu City Hospital!

Vice Director Song was a highly proud vice director of general surgery who wouldn’t even be humble towards Director Zhao of general surgery. Yet, Vice Director Song was now voluntarily acting like a subordinate doctor towards Zhang Fan. This was all because of Vice Director Song’s respect for Zhang Fan’s skills!

Was this that easy? It was really difficult to make a prideful man like Vice Director Song be respectful of another! In fact, he would even refer to Director Zhao as Old Zhao rather than by title! This was because Director Zhao’s skills were only slightly better than his, instead of by a large margin like Zhang Fan’s skill! This was how highly skilled people were. They were quite simple and stubborn, yet they would forever respect those who were even more skilled!

“Continue!” Zhang Fan nodded and continued working on the surgery. Right now, this surgery was only slightly more than half finished.

Meanwhile, Old Yang had long since been brought over to the ICU department. His vitals were all stable. His contractor boss heaved a sigh of relief!

At the same time, the teenaged girl’s mother and uncle were incredibly anxious. More than 10 hours had passed already, so why hadn’t the teenaged girl come out yet from surgery?

“Brother, find someone to ask what’s going on! Just what is going on with my daughter Yaya? I’m worrying so much! My eyes keep twitching! Could it be that… Yaya! Yaya!” the mother then started crying again!

“I’ll try and find out! Don’t cry, as that won’t do anything!”