Surgery Again

I am delighted with the all clear on my latest cancer surveillance scan. But there is a downside. It means I will shortly have to go into hospital for surgery: a thoracotomy to repair a diaphragmatic hernia. Last month I met the surgeon at the Royal Victoria Hospital. He explained the procedure and the risks and I signed the consent form. He told me that the surgery would be scheduled for this month, conditional on my scan being all clear. So now I am waiting for the phone call from the hospital. Frankly, I am dreading it.

This surgery is needed to repair a hole in my left diaphragm that was caused by the first big operation I had in 2011. I then needed open heart surgery to safely remove the tumour that had grown up my vena cava. My chest was opened up and the diaphragm cut as part of this procedure. At the conclusion of this long and complex operation, either the diaphragm was not sewn up properly or some of the stitches did not hold.

Some six months after the big operation I was offered surgery to repair the diaphragmatic hernia. I was still in a lot of pain from the big surgery, so I deferred it. Six months later I was again offered the surgery, I wasn’t mentally ready to go back in for another big operation so I deferred it again. At the next review, as I had learned to adapt to my limitations, the surgeon suggested that I continue to manage the problem conservatively (i.e. without surgery).

I did this for another year or so, but then I developed asthma. The specialist reckoned this was due to my left lung being under stress because my stomach was wedged in the diaphragm. I was living with restricted breathing, particularly after eating. He recommended that I again consider surgery to repair the hernia. I met the surgeon two years ago and was discussing having elective surgery when I got the first of my cancer recurrences, followed by the first of my post-operative lung collapses.

So to cut a long story short, here I am nine months after the surgery to remove the second cancer recurrence and I am now preparing to go back in to have more surgery. It aims to restore my normal anatomy and should prevent further lung collapses. Fingers crossed that this will be the end of it.

Because of the two recent operations I was forced to have, I am now much more experienced and know that I can recover from the ordeal of major surgery. But I realise that this operation is bigger than the two previous ones. And when the surgeon tells you that you will be ‘sore’ for three months afterwards (they normally minimise these cautions), it means you will be in a lot of pain for some considerable time: at least six months and probably longer.

A thoracotomy means that your ribs are split open to gain access to your lung and diaphragm. The muscles between the ribs are cut and they take a long time to repair. Nerves run along the edges of the ribs too and are easily damaged (one of the risks). Anyone who has had bruised ribs will know how painful it is just breathing, let alone coughing and sneezing.

The other issue is that the exact nature of the hernia and the extent of the repair will only be known after I am opened up. So how likely the procedure is to be successful is also unknown in advance.

My stomach has become fused to my diaphragm, so they have to be surgically separated. This means the very delicate cutting away of the tissues of the diaphragm from the stomach, being careful not to injure it (one of the main risks). Then the hole in the diaphragm is repaired with a polypropylene mesh patch that is stitched in place.

I am told I will be in hospital for up to two weeks and incapacitated at home for three months or more. I will also have to be very careful for a good while and not undertake any activity which could pull the stitches in my hernia repair.

I have met the surgeon three times and have asked lots of questions. But when I signed the consent form my heart sank. The rational part of my mind realises that it is sensible to have this surgery, but the rest of me is in a state of fear. I've had enough of hospitals and surgery. I am dreading the call. It could come any day now.