Chapter 297 - The Crown Jewel (Part 1 of 4) (1/2)

“An emergency?” Su Yun frowned at the mention of the transjugular intrahepatic portosystemic shunt (TIPS) surgery.

The TIPS surgery was hands down the most difficult type of interventional surgery.

Of course, there were many new surgical methods that required certain medical facilities to pull off; the prostate interventional embolization, for example. These surgeries were already considered difficult, but the TIPS surgery demanded the most skill.

“There is a patient in the gastroenterology department, a friend of Department Chief Xia’s, with complications. They had arranged for a surgery in Imperial Capital Hospital but the patient started vomiting blood and is now in critical condition,” Zheng Ren explained as he rose from his seat and put on his white coat, shooting Xie Yiren an apologetic look.

Xie Yiren gave him a wave of support. Her brown-eyed gaze softened as she watched Zheng Ren hurriedly dress for duty.

Rea.s.sured, Zheng Ren strode confidently out of the on-call room.

“Can you perform the surgery?” Su Yun asked when he caught up.

“I can try.” Zheng Ren had never done it before but had some training time saved up in the System. He was willing to spend all his points to save a life.

Postsurgical care was the most complicated part of a TIPS surgery.

To address decompensated cirrhosis and its resulting symptoms, esophageal varices and splenomegaly, there were two methods: the first was a splenectomy and porto-azygos disconnection. The second method was TIPS.

This surgery had barely 30 years of history in a clinical setting.

A German research team, headed by Richter, was the first to perform a transjugular intrahepatic portosystemic shunt surgery in 1988. In 1991, they published a paper detailing 16 successful procedures.

Later, Zemel (1991) and Ring (1992) also reported success.

In 1993, the procedure was introduced to other countries.

The first TIPS surgery locally was performed at the turn of the 21st century by Professor Xu Ke’s team from China Medical University.

To this day, the procedure was rarely used in hospitals.

Why?

It was difficult.

Extremely difficult.

Moreover, the post-surgery survival rate was not high.

However, if the patient managed to recover, the benefits of having a shunt in place were huge.

Su Yun had recently started reading up on interventional radiology-a.s.sisted procedures and knew that TIPS was the crown jewel of interventional surgery.

Was Zheng Ren going to try it now? Did the hospital even have the necessary instruments and materials?

“Do we have the necessary items?”

“I’ll call Manager Feng,” Zheng Ren said as he scrolled through his phone contacts.

“Manager Feng, it’s Zheng Ren.

“We’re starting a TIPS surgery. Please send over the relevant materials immediately.

“Yes. Old Chief Physician Pan will handle the procurement doc.u.mentation tomorrow.

“We need it in an hour!”

He hung up.

“Are you confident with post-surgery care?” He said, his footsteps quickening.

Su Yun recalled the TIPS procedure and its risks. “If we can’t prevent hepatic encephalopathy, we can only prescribe amino acids to hopefully control its progression.”

The key lay in managing the potential onset of hepatic encephalopathy.

Zheng Ren mulled the risks over as they arrived at the gastroenterology department.

Department Chief Xia felt some embarra.s.sment when she saw him.

Their first meeting had involved the floating gallbladder.

After Zheng Ren was proven correct, Department Chief Xia had been reluctant to cross paths with the emergency department chief resident.

Even for emergency procedures, she called up Old Chief Physician Pan instead… It was the proper channel to go through as favors were traded among department chiefs.

“Good day, Chief Xia. May I know which room the patient is in?” Zheng Ren asked with a neutral expression. There was no pride or sarcasm in his tone. It was as if their previous encounter had never happened.

“Right this way.” Department Chief Xia put aside her misgivings for the chief resident and brought the two doctors to the resuscitation room.

It was a male patient in his fifties with jaundice-yellow skin and a deathly miasma surrounding him. He held a basin in his hands to catch the dark venous blood pouring from his mouth.

It was like a scene from h.e.l.l.

The strong stench of blood filled the room. Zheng Ren glanced at the System’s display.

It gleamed a dangerous red.

The System diagnosed hemorrhagic shock, decompensated cirrhosis, refractory ascites, hydrothorax and electrolyte imbalance.

This patient had just recently undergone a splenectomy and porto-azygos disconnection…

Zheng Ren had been deciding between two procedures but was now left with one.

“The vomiting started three days ago. He had just come out of a splenectomy and porto-azygos disconnection surgery, hence the conservative treatment. We managed to control the bleeding with a combination of three hemostatic drugs and epinephrine, but when we were calling the ambulance for a transfer to Imperial Capital, the patient started vomiting large amounts of blood.”

A c.o.c.ktail of three hemostatic drugs alongside epinephrine was an extreme measure.

Administering more than three drugs only increased the risk of complications. A cerebral or myocardial infarction could worsen things.

Zheng Ren took a deep breath and calculated his remaining intensive training time.

After all, the TIPS surgery was the toughest procedure in the world of interventional surgery. Zheng Ren was not confident in his current abilities.