Famous Among Top Surgeons in the 90s

Clinically, it's simply referred to as a gastric tube, which is relatively short and easy to insert. The passage from the nose to the esophagus to the stomach is quite straightforward without much bending, and it is usually inserted blindly by nurses.

Other tubes are more complex, such as nasoduodenal tubes, nasojejunal tubes, and jejunostomy tubes, all of which must be inserted into the intestines. A person's intestines are twisted and winding, similar to a maze, making blind insertion extremely difficult. Generally, these are placed during a surgical procedure by a surgeon or inserted with the aid of a digestive endoscope under direct visualization.

For patients who have undergone gastrointestinal surgery, leaving such tubes during surgery is a routine risk consideration by surgeons, taking into account the possibility of postoperative anastomotic leaks, as a precaution.

Patients with anastomotic leaks cannot take food orally as it leaks through the stoma, causing internal infection. Fasting is required upstream of the leak. The presence of a nutritional tube reaching below the leak allows continued enteral nutrition support, which is called the "lifeline" for such patients. Similarly, since this patient developed an anastomotic leak post-surgery and the leak hasn't healed, the nasojejunal tube has not been removed. Surely, a jejunostomy is not needed yet.

Earlier, anastomotic leaks were mentioned. Now, discussing anastomotic leaks again shows their close correlation with surgical procedures. Thus, the prefix "anastomotic" is intentionally added to the leak. Not all leaks can be attributed to surgical causes. More often, leaks in a patient's body result from inherent diseases or trauma, such as anal or intestinal fistulas unrelated to surgery, and shouldn't be labeled as anastomotic leaks.

As the name suggests, an anastomosis is the junction where healthy tissue organs are reconnected after the diseased part is resected. The procedure known as an anastomosis thus leads to this junction being called an anastomotic site.

To accurately understand these terminologies is essential in identifying potential sites of anastomotic leaks. To manage an anastomotic leak, a doctor must first locate the leak. However, finding the leak isn't straightforward. Logically, since an anastomotic leak is surgery-related, the Chief Surgeon best knows where the anastomosis site is and could locate the leak there. The Chief Surgeon could do this, but it requires another surgical procedure, whether open or laparoscopic, both of which are quite invasive. The patient may not be able to endure another long stay on the operating table. This particular patient's condition is quite weak. Surgeons must reconsider before opting for surgery again, so the primary choice isn't a surgical intervention to fix the leak, avoiding the patient not being able to withstand surgery.

Without surgery, the leak can be found within the patient's digestive tract using a digestive endoscope. Unlike surgery, where the intestines can be exposed to find the leak, an endoscope relies on a limited view and limited auxiliary tools to locate and seal the leak. Thus, a medical expert might showcase their skills in how well they can handle a digestive endoscope.

Senior Kang often mentioned that Senior Brother Yu is an expert in endoscopic techniques. Xie Wanying and her two classmates continued to learn by listening to the conversation between Senior Brother Yu and Doctor Shao.

"Have you tried titanium clips, and they didn't work?" Yu Xuexian asked.

"Yes, yes." Doctor Shao nodded.

"Then they weren't clipped in the right spot," Yu Xuexian diagnosed the issue accurately, pointing out that the large leak wasn't secured correctly.