Yes, I Did Hold a Stomach

These past two weeks have really shown me that no two days are the same when working as a clinical dietitian. There are always different patients with different cases that make for varying assessments and interventions. You never really know what new types of patient you may interact with the morning you walk into work. This past Thursday, February 25th, was quite different than all the internship days before.

My preceptor had the chance of getting me into watching a gastric sleeve surgery on Thursday morning, which, to say the least, I was stoked for. Everyone kept warning me to eat before and "try not to faint," but that never came to be an issue for me with how excited I was throughout the entire procedure.

Although the surgeon was a little late to surgery time, I still didn't build up much pre-surgery anxiety, which I thought might happen for me.

I got all dressed up in the hospital's scrubs, looking like a complete RN for the day (HOKAS and all). I may have accidentally put one of the

shoe covers over my head instead of the correct hairnet cover, but we don't have to discuss that short-lived mistake too thoroughly.

I walked into the procedure room, ready to see my first front-row surgery. The surgical tech gave me a swivel chair (which I was very grateful for). As Dr. Kummerfeldt started working on the patient, my attention was immediately tunneled in on his skills.

A laparoscopic sleeve gastrectomy removes about 75% of the stomach, leaving a narrow gastric sleeve that resembles the shape of a "banana," as the doctor would say. After he made the incisions in the abdominal wall, the doctor had to use a tool to lift the liver off of the stomach and keep it lifted throughout the procedure. Next he had to cut the fat off of the stomach lining. In this case, the patient's abdominal fat was extremely thick, and it was frustrating for the doctor to cut through.

Once he cut around the greater curvature of the stomach, a Bougie tube was put into the patient's stomach to serve as a sizer for the new stomach; To my surprise, the new stomach section was much smaller than I had imagined. The doctor made markings where he would cut the removal section of the stomach off. He made his first cut about 6 cm from the pylorus, which is the valve between the stomach and small intestine. The stapler cuts through the stomach and staples simultaneously, taking several seconds to fully leave behind the staple barrier. I couldn't believe how easily the staples adhered to the lining of the stomach. After he had cut all the way through to the other end of the stomach, it had been completely divided into two parts.

Once about 75% of the stomach had been removed, it was decompressed and taken out through a small incision mark. What I didn't expect was the chance to HOLD THE REMOVED STOMACH. Once it was taken out of the abdomen, the surgical nurse looked at me and said, "Throw on some gloves." She then handed me the stomach. I couldn't really think thoroughly in the moment, but let me tell you, stomachs are very odd-feeling. Feeling the staples was really fascinating as well; I could not fathom how those small steel pieces could hold the patient's stomach together for the rest of their life.

Overall the surgery was amazing to watch. I did my best to achieve this competency, CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice. Before I went in the morning of surgery, I spent the entire evening before researching sleeve gastrectomies. I watched several of the online available surgery videos, but I also spent time looking into how a dietitian can help a patient before and after surgery. I recently made a handout for my preceptor for post-bariatric surgery patients on how to correctly reintroduce liquids, pureed foods, and solid foods into one's diet. The emerging research within dietetics practice for a patient who has gotten a sleeve gastrectomy is insightful.

Here's a small infographic to provide some more information on why a patient may get a sleeve gastrectomy:

As you can imagine, the rest of that afternoon was not nearly as impressive as the morning, but it was a fantastic day overall.

The previous week was full of ice and snow, and then even more and more snow. When one of the days reached about three inches of snow, 10+ food service employees were unable to drive to the hospital to work, so I went down to the kitchen as help.

I worked with a lovely woman named Amanda all day in the TJ Cafe. It was actually really nice to help those workers and serve all the familiar faces I see around the hospital every weekday. Since I get lunch for free as an intern, it felt nice to give back to the sweet cafe ladies.

The overall week had been full of charting, educations, and kind patients. The surgery was a cherry on top of all the learning I have received in this clinical setting at TJ Samson Hospital.

References:

Gastric sleeve illustrations. (n.d.). Retrieved February 27, 2021, from http://surgery.ucla.edu/bariatrics- gastric-sleeve-illustrations

Gastric sleeve surgery. (n.d.). Retrieved February 27, 2021, from https://my.clevelandclinic.org/departments/bariatric/treatments/gastric-sleeve

Sleeve Gastrectomy Infographic [Digital image]. (n.d.). Retrieved February 27, 2021, from https://www.nygetfit.com/sleeve-gastrectomy/

[Sleeve diagram]. (2016). Retrieved February 27, 2021, from https://www.nashvilleweightloss.com/single-post/2019/05/15/the-honest-truth-about-gastric-sleeve-surgery