Robert C Wright, MD, PS – Puyallup, Washington
Informed Consent – Intestinal (Bowel) Resection
Your symptoms, physical exam and laboratory studies suggest that you have a problem with your colon (large bowel) or small intestines, requiring its removal. The cause for a problem with the bowel are many, including cancer, bleeding, inflammatory diseases, diverticular disease, and strictures, to name a few. After careful consideration, a bowel resection is the procedure that has been recommended.
Description of the Procedure
Bowel cleansing will be performed for several days preceding colon surgery. At surgery, an incision is placed either horizontally or vertically on your abdomen overlying the bowel to be removed. The section of bowel to be removed is identified and released from surrounding structures. The diseased bowel and its blood supply are divided, removed, and the remaining bowel is stapled or sutured back together to restore continuity. In some cases, the video laparoscope can be used to assist the surgery.
Additional Procedures that may be done while in Surgery
It is impossible to accurately predict what we will see or encounter when we do this operation. The following procedures will be performed only if necessary.
1. Colostomy or ileostomy formation—there are times when it is deemed inadvisable or impossible to put the bowel back together, and so we’ll create a colostomy or ileostomy (bag). We may not always know that before surgery. This is always a last option. Sometimes, the colostomy can eventually be reversed.
2. Resection of contiguous organs—if the surgery is for cancer, the tumor may be growing into surrounding organs. It would be advisable to remove as much (if not all) of the tumor as possible, which may consist of removing part of the liver, stomach, pancreas, bladder, diaphragm, or abdominal wall, or removal of a kidney or the spleen.
3. Oophorectomy—if you are either postmenopausal or being treated for cancer and are female, we recommend prophylactic removal of your ovaries.
4. Gastrostomy or feeding tube placement—a tube to drain your stomach or to help your nutrition may occasionally be needed.
5. Removal of rectum and anus (abdominal-perineal resection)—this will always result in a permanent colostomy/ileostomy, and is performed if the disease process (usually cancer) extends too low in the rectum to safely put the bowel back together. This is mostly a concern for rectal cancer.
Alternatives/Benefits for Treatment
Alternative treatments will depend on the disease process. For most diseases, the nonsurgical approach has been tried and has proven inadequate. The benefits of surgery also depend on the disease process involved; most people are healthier following recovery from surgery.
Risks/Complications of Treatment
Treatment risks fall into two categories; those that could happen during any operation under anesthesia, and those that are specific for a bowel resection. In any medical treatment, it is impossible to predict all the things that could go wrong. Fortunately, complications are the exception rather than the rule. Every reasonable effort is made to avoid complications. The most common possible complications are as follows:
Possible complications of major surgery
1. Bleeding – this is a problem that could happen any time the skin is cut. The need for a blood transfusion is rare.
2. Infection – we take special care to prevent an infection, but it is always a possibility. Especially for an emergency surgery.
3. Reactions to medication – this could be many things, from a minor rash to possible death.
4. Reactions to anesthesia and surgery – this could show up as a heart attack, blood clots, pneumonia, sore throat, or potential death, in rare cases.
5. Poor wound healing – breakdown of the incision.
(see other side)
Possible complications of a bowel resection
1. Hernia at the incision site—this is uncommon, but would require surgical repair.
2. Bowel or abdominal organ injury—an injury to a portion of the intestines, pancreas, or other abdominal organs is uncommon but possible during this option. Should this occur, we will repair the injury. Re-operation may be required.
3. Anastomotic leak—this is a leak in the area where we sew or staple the bowel together. It is uncommon but can happen any time you operate on the bowel. A leak may result in another operation, and possibly a colostomy.
4. Recurrence of the disease—inflammatory bowel disease, cancer, diverticular disease, or bleeding can recur based solely on the nature of the disease process.
5. Diarrhea or change in bowel habits—removal of sections of bowel may result in either temporary or prolonged change in bowel habits, that may occasionally interfere with a person’s usual lifestyle.
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual. You should begin walking on the evening of surgery. You will require hospitalization following surgery because of an expected period of bowel dysfunction (ileus) that happens after bowel surgery. You will be discharged from the hospital when you are able to walk, eat, void, and have bowel movements. You should not drive a motor vehicle while on pain medication. You should not lift anything greater than fifteen pounds for several weeks following the operation. After that time, you will only be restricted from activity that causes discomfort. Most people are able to return to office work or “light duty” three weeks following the operation.
If you are being treated for cancer, further treatment of the cancer may be required, including chemotherapy and possibly radiation therapy. The final pathology report after surgery will strongly influence this decision.
Consent for Treatment
I understand my condition to be a problem with the intestines (bowel) and am aware of its risks if untreated. I have read and understand the above explanation of the procedure being proposed. My surgeon has answered my questions, and I choose to proceed with surgery.
I understand that every operation may yield unexpected findings. I give the surgeon permission to act on his best judgment in deciding to remove or biopsy tissues that appear to be diseased, understanding that complications may arise from that action.
I understand that while most people with diseases of the intestines may benefit from this operation, I may not. My condition may not improve, and it may worsen. No absolute guarantee can be made.
HIPAA: Before and after surgery, unless otherwise requested in writing by you, visitors whom you invite to attend the surgery will be informed of the surgical finding, your surgical status, and anticipated recovery issues, for effectiveness of communications. Because of the anesthetic, you may or may not remember these important details
Print NamE______
Signature ______Date ______
Witness ______Date ______
Surgeon ______Date ______
Relationship to Patient if Signature of Legal Guardian ______
I waive the right to read this form, and do not want to be educated and informed of treatment risks; nonetheless I understand the need for this surgery and grant permission to the surgeon to proceed on my behalf.
Signature ______Date ______
rev6-03/kab