CHAPTER 120: 120 IS ENOUGH TO HOLD ITS OWN.

"Hey, Brother Li, we’re partners today. Have you received the relevant information?" Liu Banxia asked with a smile upon arriving at the operating room.

"It’s been sent over. The patient is currently undergoing intravenous fluids to regulate electrolytes. The ECG is normal, and there’s no hypertension or diabetes," Li Liwei said.

"The images show a large amount of free gas in the abdominal cavity and a perforation on the lesser curvature. We won’t know how to proceed until you perform an exploratory laparotomy."

Liu Banxia gave a thumbs up. "Doctor Liang, see? Brother Li doesn’t talk much, but every word he speaks carries weight. We need to be time-efficient during the surgery and avoid intraoperative shock."

He had a point. Although the patient was in critical condition, it was essential to manage his bodily state. Rushing the surgery could actually increase the patient’s risk.

If it weren’t for the perforation causing diffuse peritonitis, the best approach would have been conservative treatment. Surgery would only be considered if conservative treatment showed no improvement.

After about ten more minutes, the patient was wheeled in.

"Don’t be nervous. Leave it to me," Liu Banxia reassured with a smile.

The patient nodded. "This gastric tube is really uncomfortable. Will it be removed after the surgery?"

"Definitely not. The tube helps with gastrointestinal decompression before surgery. Haven’t you noticed your abdomen has shrunk a bit? It will also aid in drainage after the surgery, since you have a gastric perforation," Liu Banxia said with a smile.

"I know it’s uncomfortable having this inserted. We’ll remove it as soon as it’s medically advisable. Let’s focus on the surgery now. Rest assured, you’re in good hands."

The patient nodded.

Liu Banxia glanced at the monitor: temperature 38.9°C, blood pressure 115/80 mmHg, heart rate 110 bpm. The vitals were slightly elevated, but considering the patient was in significant abdominal pain and wouldn’t even allow palpation, a higher heart rate was to be expected.

He then carefully examined the patient’s skin. Thankfully, the jaundice hadn’t worsened significantly. Although the patient had delayed seeking treatment for some time at home, it hadn’t been too long.

Sun Fengjiao, on the other hand, was quite enthusiastic. This was, in a formal sense, her first surgery with Liu Banxia. Even though she had a higher education level, Liu Banxia currently held a higher position and possessed superior surgical skills.

Once the anesthesia had taken effect, Li Liwei nodded at Liu Banxia.

"Brother Li, this patient is a critical case. We’re counting on you to provide us with the necessary support today," Liu Banxia said.

"Just treat me to dinner sometime, that’ll do," Li Liwei replied with a serious nod.

"Liang Xiaolin, open him up," Liu Banxia stated.

Liang Xiaolin, who had been prepared, froze for a moment. She looked at Liu Banxia with a pleading, apprehensive expression.

She hadn’t expected Liu Banxia to be so bold as to let her make the first incision for the laparotomy. This isn’t a minor surgery! What should I do?

"What are you afraid of? I’m here," Liu Banxia said calmly.

"Later, when we have more staff, opportunities like this will be rare. I’ll handle the work after the abdomen is open, and Doctor Sun will take care of the closure. That way, we’ll have a clear division of labor."

"Can I... really do it? Then... how large should I make the incision?" Liang Xiaolin asked, her voice laced with hesitation.

"If I were doing it, eight centimeters would probably suffice. But considering the patient’s current condition, make it ten centimeters. It’s better to be on the safe side," Liu Banxia instructed.

"Oh," Liang Xiaolin acknowledged, turning and accepting the scalpel.

She was still incredibly nervous; she’d never actually done this before! But nervous or not, the incision had to be made. She tried to recall Liu Banxia’s movements from previous surgeries when he made incisions, took a deep breath, and brought the scalpel down.

"Very good. Perfect. Keep going," Liu Banxia nodded, satisfied.

Ordinarily, Liang Xiaolin would have definitely glared at him. But right now, she couldn’t spare a thought for anything else; all her attention was focused on opening the abdomen.

She incised layer by layer, with Liu Banxia assisting her seamlessly. By the time she had fully opened and exposed the abdominal cavity, Liang Xiaolin felt as if more than half her strength had been drained.

So the pressure during surgery is actually this intense! Why does Liu Banxia always seem so relaxed?

"Exploration reveals a large amount of greenish pus, at least 3,000 mL. There’s widespread, extensive edema of the peritoneum and intestinal paralysis. Suction," Liu Banxia said, taking over the primary surgeon’s position.

"This patient is truly fortunate to have come in when he did. If he had delayed a few more hours, the outcome would be very uncertain. I doubt even Director Zhou himself would have had much chance of success by then."

"Dr. Liu, everyone says you’re very fast in surgery. How long do you estimate this one will take?" Sun Fengjiao asked curiously.

"Me, fast? I don’t think I’m particularly fast," Liu Banxia replied casually.

"It’s hard to say for this one. The main challenge will be cleaning the abdominal cavity. The suturing itself should be straightforward. We can see the size of the perforation now; hopefully, it’s small."

After suctioning all the exudate and gastric contents from the abdominal cavity, Liu Banxia began searching for the perforation site using atraumatic oval forceps.

This wasn’t a quick task; the X-ray had only indicated an approximate location. During the search, any instrument that touched the exudate was considered contaminated and had to be immediately replaced.

"He’s incredibly lucky. The perforation is about 0.6 centimeters; it’ll be easy to suture," Liu Banxia said, exhaling in relief after locating the perforation.

"That’s the advantage of seeking treatment early. If he’d delayed any longer, the situation would be much more uncertain. Since the perforation is small, less gastric fluid leaked out. Does that mean there’s likely not much damage to the surrounding organs?" Li Liwei asked.

"Yep, the prognosis should be much better. He probably won’t need to stay in the ICU for too long, which will save him a considerable amount of money," Liu Banxia nodded.

Liu Banxia first placed three interrupted sutures. He tied and cut the thread for the middle suture. For the other two, he tied knots but left the threads long.

Once that was done, he covered the perforation site with a patch of the greater omentum. Then, he used the long threads from the first and third sutures to secure the omental patch in place, tying them off and cutting the excess. With that, the suturing was complete.

"Alright, now for the most crucial part: irrigation," Liu Banxia said, stretching lazily as he stepped aside.

The remaining work could be handled by Liang Xiaolin and Sun Fengjiao. It was a straightforward, though laborious, task: repeatedly irrigating the abdominal cavity with warm saline until the fluid ran clear, signifying that it had been thoroughly cleansed.

Liu Banxia was so focused on the patient that he hadn’t even noticed Director Zhou Shuwen and Chief Director Chen Zhenxing standing in the observation gallery above the operating room.

"This young fellow is truly impressive, becoming capable of handling cases independently in such a short time. We can officially grant him some authority, define his responsibilities more clearly," Chief Director Chen Zhenxing said with a laugh.

"Please, don’t praise him too much, sir. If he overhears, there’s no telling how smug he’ll get. Haven’t you heard? He had another clash with Qin Hai just before this surgery," Zhou Shuwen said, looking troubled.

"Are you complaining, or do you feel he’s been wronged? Let’s leave it at that for now. Old Qin is indeed difficult to handle," Chen Zhenxing remarked, then turned and walked away with his hands clasped behind his back.

Zhou Shuwen glanced down at Liu Banxia, who was now leisurely chatting with Li Liwei. Shaking his head with a sigh of resignation, Zhou Shuwen also left.