Joey's second surgery was this morning and overall it went well. I've learned a lot about the liver, but am still no expert, so bare with me while I try to explain what happened today... Essentially there is a bile duct that dumps bile from the liver into the intestine. With a liver transplant, or at least with Joey's, the bile duct entrance to his intestine doesn't line up with the donor liver's bile duct. They treated this by cutting out a part of his small intestine and essentially rerouting it to the bile duct on the new liver. So now his small intestine sort of has a Y shape to it... I had someone draw a picture for us, which was a lot easier for me to understand. Probably more than you all want or need to know, but we have learned that a "liver transplant" is much more involved than we thought it was.
To maneuver around in the intestine, they ended up removing his appendix (he also had his gallbladder removed during the liver transplant surgery). Apparently the appendix and gallbladder aren't very useful... This is probably for the best since Joey's new liver is about 3 times the size of his original liver, and it is a tight squeeze in his little body. Due to that, the swelling of his other organs, and inflamed intestines from the surgeries, they decided not to close him up today. They don't want to close him up before things settle or they run the risk of cramming everything in there and blocking up a lot of the new vessels, ducts, etc. in his liver. Monday they will take a look at everything again and as of now, are planning to close him up then. If his intestines are still a bit inflamed, they may remove some of it. If he doesn't have enough fascia to cover everything inside, they will add a bit of mesh to ensure there is enough room inside for all of his bits. We are hoping to avoid the mesh, as there are risks of further surgeries down the road due to hernias. The doctors seem hopeful we can avoid that, given he is a bit of a bigger babe (he has been wearing a blood pressure cuff for a small child, instead of a baby...).
We still don't have any answers as to what caused his liver to fail, but hope to get some lab results and pathology reports tomorrow. I can't recall if I mentioned this already, but we still want to try to figure this out because it can help inform his medication needs going forward, specifically his immunosuppressants. But so far Joey and his new liver are getting along well, and his labs are looking great.
The doctors don't want to leave him intubated until Monday due to risks of infection and withdrawal. Tomorrow morning they plan to extubate him, and will re-intubate him on Monday morning for the last surgery (hopefully). We have been told to expect a very fussy baby after the extubation, so we are at home again tonight trying to get some good sleep to prepare for a long weekend of employing all of the comfort techniques we know.
Love to you all,
The Moschellas
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