It was a hectic afternoon in the Ramirez home. The kitchen sink was clogged and supplies normally stored in childproof cabinets were on the counter and floor. Three-year-old Perla, one in a set of triplets, was busy playing with her two sisters, when her mother heard a blood-curdling scream. Marie Ramirez felt her heart pound as she ran toward the sound of her daughter’s frantic crying.
Perla was hiding in a closet, holding a bottle filled with some type of liquid. Maria wasn’t sure what had happened, but she knew her daughter was in excruciating pain.
“I was very scared,” says Maria, as she recalls that unforgettable day two years ago. She rushed Perla to a local hospital near the family’s Rowland Heights home. In need of expert pediatric care, Perla was transferred by ambulance to Miller Children’s & Women’s Hospital Long Beach, where a team of specialists took over her treatment.
Perla had swallowed liquid drain clog remover, causing corrosive burns to her esophagus – the tube that carries food and liquids from the mouth to the stomach. The injury involved significant tissue damage and intense inflammation.
At first, Robert Tran, M.D., pediatric gastroenterologist, Miller Children’s, inserted a feeding tube into Perla’s stomach and treated her with antibiotics and steroids to prevent infection and reduce inflammation. He also tried opening the narrowed areas in her esophagus with balloon dilation several times. However, within a month following the incident scar tissue had formed, severely constricting the esophagus.
Eating or drinking was virtually impossible and Perla was experiencing severe weight loss. Her injuries were too extensive for conventional treatments. “The only option she had left was surgery,” explains Nam Nguyen, M.D., general surgeon, Pediatric Surgical Center, Miller Children’s.
An esophagectomy, the surgical removal of the esophagus, is a complex operation. Traditionally, it requires two large incisions across the abdomen and chest, as well as a small incision in the neck. However, at Miller Children’s, physicians are on the leading edge of minimally invasive surgeries.
Dr. Nguyen was able to perform the complicated procedure through four small incisions. A small camera attached to a scope was inserted through an incision in Perla’s belly button. The camera was projected onto a monitor, providing a “live feed” for Dr. Nguyen. Medical instruments were inserted through the other openings. During the five-hour operation, Dr. Nguyen removed Perla’s damaged esophagus. He then pulled her stomach up through the chest to the neck and attached it to the small section of the esophagus still left in place. The tube-shaped stomach is Perla’s
“Recovery from a traditional esophagectomy is typically long and painful,” explains Dr. Nguyen. “With minimally invasive surgery, children recover faster because there’s less pain, reduced scarring and fewer infections.”
Perla also was fortunate to have access to Miller Children’s state-of-the-art Pediatric Surgical Center, which is dedicated exclusively to infants, children and adolescents. Pediatric surgeons work in an environment that’s conducive to pioneering new methods. For example, Miller Children’s is one of a few specialized children’s hospitals nationwide offering single-incision laparoscopic surgery. Virtually “scarless,” this type of operation requires only an inch opening inside the belly button, effectively hiding the incision from view. This technique is successfully used in removing the gallbladder, spleen and appendix.
“With minimally invasive surgeries, the trauma to the body is reduced and we’re able to have our patients back to playing with their friends and being kids much faster,” says Dr. Nguyen.
Perla spent one day in the intensive care unit and seven days in the hospital following her surgery. She was able to eat regular food by the time she returned home. While she still visits Dr. Nguyen every six months for a check-up, the active 5-year-old is the same weight and height as her triplet sisters with no long-term complications. She looks forward to her family’s favorite weekend breakfast of over-easy eggs, cheese, tortillas and beans. She loves to ride her scooter, play soccer and go horseback riding with her family on Sundays. “The doctors at Miller Children’s gave Perla her life back,” says Maria.
Learn more about minimally invasive surgery at Miller Children’s & Women’s Hospital.