PAUL E. SAVOCA, MD, FACS, FASCRS

Transcription

1 PAUL E. SAVOCA, MD, FACS, FASCRS Cnsent Frm fr Anal Fistultmy The dctr has explained that I have the fllwing cnditin: Anal Fistula The fllwing prcedure will be perfrmed: Anal Fistultny (remval f an abnrmal cnnectin between the anus and skin) The dctr explained the risks benefits and alternatives f the prcedure t me. He has als explained the technique f the prcedure t me alng with the expected utcmes, pstperative curse and functinal results. Relevant treatment ptins (bth surgical and nn-surgical) have been explained as well as the risks f nt having the prcedure. As with any surgical prcedure there are general risks and ptential cmplicatins which include: Small areas f the lungs may cllapse, increasing the risk f chest infectin. This may need antibitics and physitherapy. Clts can frm in the legs (deep vein thrmbsis r DVT) with pain and swelling. Rarely part f this clt may break ff and g t the lungs which can be fatal. Increased risk in bese peple f wund infectin, chest infectin, heart and lung cmplicatins and thrmbsis. Increased risk in smkers f wund and chest infectins, heart and lung cmplicatins and thrmbsis. A heart attack because f strain n the heart r a strke. Death rarely is pssible due t the prcedure Risks/ cmplicatins specific t this peratin include: (a)there will be an pen wund where the fistula was. This will take 2-6 weeks t heal. If the fistula invlves an excessive amunt f muscle arund the anus, the dctr may insert a small elastic band r similar device (setn) t assist in drainage f infectin until definitive treatment is pssible. The cnditin may recur, and an abscess abut the anal regin may ccur. Scarring may develp abut the anus, and it may be painful r thickened.

2 Rarely the muscles at the anus may be ver stretched r ver cut with a resultant weakness in the area. This culd cause prblems with cntrl f the bwels (incntinence). A pad may need t be wrn and/r further surgery may be needed. Increased risk in bese peple f wund infectin, chest infectin, heart and lung cmplicatins and thrmbsis. PATIENT CONSENT I acknwledge that: The dctr has explained my medical cnditin and the prpsed prcedure. I understand the risks f the prcedure, including the risks that are specific t me, and the likely utcmes. The dctr has explained ther relevant treatment ptins and their assciated risks. The dctr has explained my prgnsis and the risks f nt having the prcedure. I was able t ask questins and raise cncerns with the dctr abut my cnditin, the prcedure and its risks, and my treatment ptins. My questins and cncerns have been discussed and answered t my satisfactin. I understand that the prcedure may include a bld transfusin. I understand that if rgans r tissues are remved during the surgery, that these may be retained fr tests fr a perid f time and then dispsed f sensitively by the hspital. The dctr has explained t me that if immediate life-threatening events happen during the prcedure, they will be treated accrdingly. I understand that phtgraphs r vide ftage may be taken during my peratin. I understand that n guarantee has been made that the prcedure will imprve the cnditin, and that the prcedure may make my cnditin wrse. On the basis f the abve statements, I acknwledge that: The dctr has explained my medical cnditin and the prpsed prcedure. I understand the risks f the prcedure, including the risks that are specific t me, and the likely utcmes. The dctr has explained ther relevant treatment ptins and their assciated risks. The dctr has explained my prgnsis and the risks f nt having the prcedure. I was able t ask questins and raise cncerns with the dctr abut my cnditin, the prcedure and its risks, and my treatment ptins. My questins and cncerns have been discussed and answered t my satisfactin. I understand that the prcedure may include a bld transfusin. I understand that if rgans r tissues are remved during the surgery, that these may be

3 retained fr tests fr a perid f time and then dispsed f sensitively by the hspital. The dctr has explained t me that if immediate life-threatening events happen during the prcedure, they will be treated accrdingly. I understand that phtgraphs r vide ftage may be taken during my peratin. These may then be used fr teaching health prfessinals. (Yu will nt be identified in any pht r vide.) I understand that n guarantee has been made that the prcedure will imprve the cnditin, and that the prcedure may make my cnditin wrse. On the basis f the abve statements, I REQUEST TO HAVE THE PROCEDURE. Name f Patient Signature Date DOCTOR S STATEMENT I have explained: the patient s cnditin, the need fr treatment, the prcedure and the risks, relevant treatment ptins and their risks likely cnsequences if thse risks ccur, the significant risks and prblems specific t this patient. I have given the patient/ substitute decisin-maker an pprtunity t ask questins abut any f the abve matters and raise any ther cncerns which I have answered as fully as pssible. I am f the pinin that the patient/ substitute decisin-maker understd the abve infrmatin. Name f Dctr Signature Date PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY

4 T diminish risk f bleeding please stp all aspirin; mtrin; advil; cumadin; plavix; and all nn prescriptin dietary supplements ne (1) week prir t and after the prcedure 1. The ffice may ask yu t have bld tests dne several days befre yur prcedure. This is imprtant t ensure that everything is ptimal fr yur anesthetic. Occasinally, n bld testing is needed. 2. We ask that yu d nt eat r drink anything after midnight n the evening prir t yur peratin. Fd r liquid in the stmach may cause prblems with the anesthetic r frce yur surgery t be pstpned. 3. We ask that yu take tw (2) Fleet s enemas apprximately 1 hur befre yu leave t g t the hspital n the mrning f yur prcedure. This helps clear the rectal area f fecal material and allws fr a safer and mre cmfrtable perative prcedure. Please read the instructins n the bx prir t administering the enemas. Call the ffice if yu have any questins. 4. There are several items available in any drug stre which yu may find helpful t btain and have at hme fr use after surgery: 4x4 gauze r ther absrbent pads Stl bulking agent (Benefiber, Metamucil, Fibercn, Citrucel, etc) Stl sftener (Clace, Surfak, etc) Any medicatins fr which yu were given a prescriptin 5. Fllwing these recmmendatins will facilitate the perative prcedure and pstperative recvery. DISCHARGE INSTRUCTIONS AFTER FISTULOTOMY An anal fistula is an abnrmal channel r tunnel-like chrnic infectin that starts inside the

5 anus and ends utside n the skin arund the anus. Its develpment is usually the result f a previus anal infectin r abscess. Abut 50% f peple with an anal abscess end up with a fistula. Mst fistulas are shrt and superficial and are best treated by simply pening the entire tunnel and leaving it pen t heal in gradually. Occasinally a patient can have a cmplex fistula with multiple tracts r the tunnel may traverse a cnsiderable amunt f the sphincter muscle. Fr this reasn the surgical treatment has t be individualized fr each particular patient depending n the lcatin and anatmy f the fistula. Frequently, the surgen cannt guarantee exactly what will need t be dne until the examinatin that is dne under anesthesia at the time f the surgery. It is imprtant t realize that the perative prcedure can change depending n what is fund at the time f the surgery. At times a fistula will require mre than ne surgery t cure. During a simple fistultmy the tract is pened and left t heal. Sutures are smetimes used t narrw the wund but nt clse it cmpletely. If it is decided that the fistula is t deep r in a bad psitin t pen it cmpletely, a small drain- called a setn may be inserted. Yur surgen will explain hw this will be managed in the future. Discharge instructins: Fllwing yur fistultmy, yu may experience sme mild t mderate pain r discmfrt in yur rectal area. Yu may als experience cnstipatin, difficulty urinating, and pssibly sme rectal bleeding. The fllwing are sme general guidelines fr prper care after yur prcedure. Hme Care: A small amunt f bleeding is cmmn fllwing rectal surgery. A sanitary napkin r gauze may be wrn ver the anal pening t keep the underclthing clean. When there is n lnger any bleeding r discharge, there is n need t keep the pad in place. If there is prlnged r prfuse bleeding with passage f clts, call the ffice at nce. Difficulty urinating after fistultmy is unusual, but can ccur due t spasm f the urinary sphincter resulting frm pain due t the surgery. Getting the pain under cntrl and relaxing the sphincter usually allws fr the urine t pass. Take the pain medicatin yu were prescribed and d warm sitz baths either in a bath tub r sitz basin. While saking, attempt t relax the bladder and urinate int the water. If yu are unable t urinate in the first eight hurs after yur surgery, ntify the dctr s ffice. After hurs, g t the nearest emergency rm r urgent care center. A bladder catheter will be placed and remain in place fr 2 days, yu may call the ffice t have the catheter remved. Once yu have started t urinate, drink plenty f water and fruit juices (such as prune juice) after yur surgery. Yu will be given a prescriptin fr pain medicatin. Fllw the directins given by yur dctr fr taking this medicatin. After a day r tw, if the pain is subsiding try t use just plain Tylenl t ease residual discmfrt. T avid upset stmach, take yur pain medicatin as prescribed with fd in yur stmach. Take these drugs exactly as directed. Never take mre than the recmmended dse, and d nt take the drugs mre ften than directed. If the drugs d nt seem t be wrking, call the

6 ffice fr advice. D nt share these r any ther prescriptin drugs with thers because the drug may have a cmpletely different effect n the persn fr whm it was nt prescribed. Sme peple experience drwsiness, dizziness, lightheadedness, r a false sense f well being after taking piid analgesics. Anyne wh takes these drugs shuld nt drive, use machines, r d anything else that might be dangerus until they knw hw the drug affects them. Nausea and vmiting are cmmn side effects, especially when first beginning t take the medicine. If these symptms d nt g away after the first few dses, check with the physician wh prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedatin, vmiting, if these side effects ccur, it may help if yu lie dwn after taking the medicatin. ϖ Avid strenuus activity fr 1 week after yur prcedure. ϖ Take sitz baths (sit fr minutes in warm water) three times a day and after each bwel mvement fr the first few days. ϖ If yu were given a tpical intment, place this ver the anal skin and a little int the anal canal 2-3 times a day. ϖ Dn t wrry if yu have sme bleeding, discharge, r itching during yur recvery. This is nrmal. ϖ Avid cnstipatin. Take Benefiber r ther psyllium prduct (Metamucil, Citrucel, Knsyl, etc) ne teaspn twice a day. Take a stl sftener such as Clace r Surfak twice a day as well. If yu have nt had a bwel mvement by the mrning f the furth day fllwing surgery, take 2 fleet enemas, 1 hur apart (lubricate the tip f the enema well with Vaseline and insert gently). If n result, drink ne bttle f citrate f magnesium, which can be purchased at any pharmacy. Fllwing the first bwel mvement, yu shuld have a bwel mvement at least every ther day. If 2 days pass withut a bwel mvement, take an unce f milk f magnesia. Repeat in 6 hurs if n result. The use f dry tilet tissue shuld be avided. After bwel mvements use a wet Kleenex, cttn r Tuck s pads t clean yurself, r if pssible, take a warm bath. If yu were given a prescriptin fr an intment, apply this tw r three times a day at the edge f the anal pening. ϖ Eat a regular diet including plenty f fresh fruit and vegetables. Drink 6-8 glasses f water a day. ϖ Call the ffice if yur temperature is greater than 101 degrees.

7 Fllw-Up Make a fllw-up appintment as directed by ur staff. The first fllw up is usually 3 weeks fllwing surgery, but if a setn was placed the surgen may want t see yu sner.