We took the bandages off Anya's thigh this evening and the incision is healing very nicely. She tolerated the whole thing like an absolute champ. She didn't show any signs of pain or discomfort. I will say however the incision is much larger than I thought it would be. I was expecting (because it's what what we were told) it to be about a half-inch. Instead it is closer to 2 inches. Oh well, no one should be looking at my daughter's legs anyway (dad writing this).
Prior to meeting with the surgeon the decision to redo Anya's nissen felts a bit like the decision to sign the "Stimulus Package", we don't feel comfortable doing it, it may not help at all, it may actually hurt the situation but thing have gotten so bad that we have no real choice but to just do something. However, after our meeting we both feel very comfortable that this is the right decision. We reviewed her upper GI results and could clearly see that over 25% OF her stomach had migrated up above the diaphragm. It is a severe paraesophogeal hiatal hernia. It is difficult to say if this is the cause of the vomiting or rather the result of the vomiting. In either case it's not good and must be corrected. Hiatal hernias are common following a nissen, especially one done at such an early age (5-days old). Anya has had upper GI's in the past but we were always told everything was normal. Out of couriosity I reviewed her Upper GI report that she had done after the first month of this vomiting starting when she was 5 months old. It reads:
"...Barium extends into the rap portion of the fundus which appears to extend above the diaphragmatic hiatus..." Now I'm sure I've read through this report before because I've read over all her records time and time again looking for answers. The difference this time is that I now better know my (her) anatomy, and know now that what that says is that she's had this Hiatal Herina for TWO years.. (I'm just going to bite my tongue here......)
Here's my theory... I thing that along with her Paraesophogeal Herina she could also have a "Sliding hiatal hernia" which is just what it sounds like, a hernia that periodically slides up and down. Perhaps the hernia noted in her earlier Upper GI was not large enough to be concerning because it may not have been done while she was vomiting or rather while it was at it's maximum herniation. I have to review out journal but I don't think we had started journaling yet.Perhaps the stomach gets forced up through the diaphragm as she gains a little weight or start taking in the recommended calories, causing it to be cyclic. As she stops eating and looses water and mass, the stomach drops back into place in the abdomen. Just a theory. Anyway it needs to be fixed, and unlike the Stimulus package, I now think this could actually be a viable solution!
So now what... Anya goes back in for surgery on Thursday, Feb 27 which fortunately gives me a good excuse to get out of my vasectomy (phew, that was close). Unfortunately because our surgeon is a dinosaur (his words, not mine) this surgery will not be done laproscopically like the first time. The plus side is that this guy has a much lower failure rate (1%) versus the national average of 15% (failures are when the nissen comes undone and a hernia occurs like in Anya's case. With his technique he adds many more internal stitching for reinforcement. Whatever works... We are very comfortable with this surgeon and needed to just bury of concerns of the huge 6" scar across her belly. I remember on her first surgery when I was concerned with those little laproscopic scars. In hindsight, no big deal. I'm sure it'll be the same for this one. We are just so excited to have possibly found the answer to her vomiting so she can grow and have an opportunity to thrive. She's so dang cute sitting here next to me. I'll try to get some new pictures out soon..
