Hemorrhoid Surgery

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Consent Form for Hemorrhoidectomy

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition: Hemorrhoids- abnormally enlarged anal veins. The following procedure will be performed:
Hemorrhoidectomy ( Removal of large veins around the anus)

The doctor explained the risks benefits and alternatives of the procedure to me. He has also explained the technique of the procedure to me along with the expected outcomes, postoperative course and functional results. Relevant treatment options (both surgical and non-surgical) have been explained as well as the risks of not having the procedure.

As with any surgical procedure there are general risks and potential complications which include:
Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.

Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal. Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.

Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis

A heart attack because of strain on the heart or a stroke.

Death rarely is possible due to the procedure

Risks/ complications specific to this operation include:

There may be difficulty passing your urine and a catheter may have to be inserted into the bladder.

The tissues about the anus may swell up considerably.

Blood may be passed with bowel actions for some days after the operation.

Heavy bleeding from the hemorrhoid wound can occur one to two weeks after the surgery needing further surgery.

The anus may scar up in the years to come and cause a stricture, i.e. narrowing.

More hemorrhoids can occur in the future (recurrence)

Wound infection requiring treatment with antibiotics and occasionally additional surgery

PATIENT CONSENT
I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.

The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

I understand that the procedure may include a blood transfusion.

I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.

The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.

I understand that photographs or video footage may be taken during my operation. These may then be used for teaching health professionals. (You will not be identified in any photo or video.)

I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,
I REQUEST TO HAVE THE PROCEDURE.

Name of Patient/ Substitute decision maker
Signature_________________________________
Date _____________________________________

DOCTOR’S STATEMENT
I have explained: the patient’s condition, the need for treatment, the procedure and the risks, relevant treatment options and their risks likely consequences if those risks occur, the significant risks and problems specific to this patient. I have given the patient/ substitute decision-maker an opportunity to ask questions about any of the above matters and raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.
Name of Doctor___________________________________
Signature________________________________________
Date ____________________________________________

PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY

To diminish risk of bleeding please stop all aspirin; motrin; advil; coumadin; plavix; and all non prescription dietary supplements one (1) week prior to and after the procedure

1. The office may ask you to have blood tests done several days before your procedure. This is important to ensure that everything is optimal for your anesthetic. Occasionally, no blood testing is needed.
2. We ask that you do not eat or drink anything after midnight on the evening prior to your operation. Food or liquid in the stomach may cause problems with the anesthetic or force your surgery to be postponed.
3. We ask that you take two (2) Fleet’s enemas approximately 1 hour before you leave to go to the hospital on the morning of your procedure. This helps clear the rectal area of fecal material and allows for a safer and more comfortable operative procedure. Please read the instructions on the box prior to administering the enemas. Call the office if you have any questions.
4. There are several items available in any drug store which you may find helpful to obtain and have at home for use after surgery:
· 4×4 gauze or other absorbent pads
· Stool bulking agent (Benefiber, Metamucil, Fibercon, Citrucel, etc)
· Stool softener (Colace, Surfak, etc)
· Any medications for which you were given a prescription
5. Following these recommendations will facilitate the operative procedure and postoperative recovery.

Discharge Instructions for Hemorrhoid Surgery
You had surgery to remove hemorrhoids (also called a hemorrhoidectomy). Hemorrhoids are swollen (enlarged, dilated) veins inside and outside the anus. Hemorrhoids are usually caused by increased pressure, such as straining when constipated or pressure during pregnancy. Hemorrhoids may cause pain, bleeding, blood clots, and itching. Complete recovery from hemorrhoid surgery typically takes about 4 weeks.

Following your hemorrhoidectomy, you will experience pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care
• A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. If there is prolonged or profuse bleeding with passage of clots, call the office at once. In some patients a packing will have been placed in the anus at the end of the surgery. This will dissolve and pass with the first bowel movement.
• Difficulty urinating after hemorrhoidectomy is usually due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.
• You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach. Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking these medicines. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.
• Avoid strenuous activity for 1-2 weeks after your procedure.
• Ask someone to drive you to appointments until you are able to sit and move comfortably.
• Take sitz baths (sit for 15-20 minutes in warm water) at least 3 times a day and after each bowel movement.
• Don’t worry if you have some bleeding, discharge, or itching during your recovery. This is normal.
• To avoid constipation take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
• If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
• The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
• Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of water a day.
• Call the office if your temperature is greater than 101 degrees.

Follow-Up
Make a follow-up appointment as directed by our staff. The first follow up is usually 3 weeks following surgery.

Fissure Surgery

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Consent Form for Lateral Internal Sphincterotomy

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
ANAL FISSURE/ANAL STENOSIS

The following procedure will be performed:
LATERAL INTERNAL SPHINCTEROTOMY

The doctor has explained the risks benefits and alternatives of the procedure to me. He has also explained the technique of the procedure to me along with the expected outcomes, postoperative course and functional results. Relevant treatment options (both surgical and non-surgical) have been explained as well as the risks of not having the procedure.

As with any surgical procedure there are general risks and potential complications which include:
Small areas of the lungs may collapse, increasing the risk of chest infection.

Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal. Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.

Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis, heart attack or stroke. Death rarely is possible due to the procedure

Risks/ complications specific to this operation include:
There may be difficulty passing your urine and a catheter may have to be inserted into the bladder.
The tissues about the anus may swell up considerably.

Blood may be passed with bowel actions for some days after the operation and rarely, heavy bleeding from the wound can occur one to two weeks after the surgery requiring further surgery.

Wound infection requiring treatment with antibiotics and occasionally additional surgery

The condition can recur necessitating further surgery

Rarely, the anal muscle may be weakened causing issues with bowel control

PATIENT CONSENT
I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
I understand that the procedure may include a blood transfusion.
I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
I understand that photographs or video footage may be taken during my operation. These may then be used for teaching health professionals. (You will not be identified in any photo or video.)
I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,
I REQUEST TO HAVE THE PROCEDURE.

Name of Patient/ Substitute decision maker_________________________________
Signature/Date_______________________________________

DOCTOR’S STATEMENT
I have explained: the patient’s condition, the need for treatment, the procedure and the risks, relevant treatment options and their risks likely consequences if those risks occur, the significant risks and problems specific to this patient.

I have given the patient/ substitute decision-maker an opportunity to ask questions about any of the above matters and raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.

Signature________________________________________

Paul E. Savoca, MD, FACS, FASCRS

PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY

To diminish risk of bleeding please stop all aspirin; motrin; advil; coumadin; plavix; and all non prescription dietary supplements one (1) week prior to and after the procedure
1. The office may ask you to have blood tests done several days before your procedure. This is important to ensure that everything is optimal for your anesthetic. Occasionally, no blood testing is needed.
2. We ask that you do not eat or drink anything after midnight on the evening prior to your operation. Food or liquid in the stomach may cause problems with the anesthetic or force your surgery to be postponed.
3. We ask that you take two (2) Fleet’s enemas approximately 1 hour before you leave to go to the hospital on the morning of your procedure. This helps clear the rectal area of fecal material and allows for a safer and more comfortable operative procedure. Please read the instructions on the box prior to administering the enemas. Call the office if you have any questions.
4. There are several items available in any drug store which you may find helpful to obtain and have at home for use after surgery:
· 4×4 gauze or other absorbent pads
· Stool bulking agent (Benefiber, Metamucil, Fibercon, Citrucel, etc)
· Stool softener (Colace, Surfak, etc)
· Any medications for which you were given a prescription
5. Following these recommendations will facilitate the operative procedure and postoperative recovery.

SPHINCTEROTOMY DISCHARGE INSTRUCTIONS.
A sphincterotomy is a procedure performed to treat anal fissures. An anal fissure is a split in the lining of the anal canal, possibly resulting from a hard bowel movement.
Muscle spasms and subsequent bowel movements prevent healing.
During a sphincterotomy, the outermost part of the internal anal sphincter is cut. This breaks the muscle spasm, improving blood flow to the area of the fissure, resulting in relief of pain and healing of the fissure.

Discharge instructions
Following your sphincterotomy, you may experience some mild to moderate pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care
• A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. When there is no longer any bleeding or discharge, there is no need to keep the pad in place. If there is prolonged or profuse bleeding with passage of clots, call the office at once.
• Difficulty urinating after sphincterotomy is unusual but can occur due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.
• Some patients have less pain after the surgery than they had prior to the surgery, but this is difficult to predict. You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. After a day or two, if the pain is subsiding try to use just plain Tylenol to ease residual discomfort. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.
Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed.
Some people experience drowsiness, dizziness, lightheadedness, or a false sense of wellbeing after taking opioid analgesics. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.

  • Avoid strenuous activity for 1 week after your procedure.
  • Take sitz baths (sit for 15-20 minutes in warm water) three times a day and after each bowel movement for the first few days.
  • Don’t worry if you have some bleeding, discharge, or itching during your recovery.
    This is normal.
  • Avoid constipation.
    o Take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
    o If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
    o The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
    o If you were given a prescription for an ointment, apply this two or three times a day at the edge of the anal opening.
  • Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of water a day.
  • Call the office if your temperature is greater than 101 degrees.

Follow-Up
Make a follow-up appointment as directed by our staff. The first follow up is usually 3 weeks following surgery.

Fistula Surgery

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Consent Form for Anal Fistulotomy

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
Anal Fistula

The following procedure will be performed:
Anal Fistulotony
(removal of an abnormal connection between the anus and skin)

The doctor explained the risks benefits and alternatives of the procedure to me. He has also explained the technique of the procedure to me along with the expected outcomes, postoperative course and functional results. Relevant treatment options (both surgical and non-surgical) have been explained as well as the risks of not having the procedure.

As with any surgical procedure there are general risks and potential complications which include:
Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.

Clots can form in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal. Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.

Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.
A heart attack because of strain on the heart or a stroke.

Death rarely is possible due to the procedure

Risks/ complications specific to this operation include:

  • There will be an open wound where the fistula was. This will take 2-6 weeks to heal.
  • If the fistula involves an excessive amount of muscle around the anus, the doctor may insert
    a small elastic band or similar device (seton) to assist in drainage of infection until definitive treatment is possible.
  • The condition may recur, and an abscess about the anal region may occur.
  • Scarring may develop about the anus, and it may be painful or thickened.
  • Rarely the muscles at the anus may be over stretched or over cut with a resultant weakness
    in the area. This could cause problems with control of the bowels (incontinence). A pad may need to be worn and/or further surgery may be needed.
  • Increased risk in obese people of wound infection, chest infection, heart and lung
    complications and thrombosis.

PATIENT CONSENT

I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.

The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.

I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

I understand that the procedure may include a blood transfusion.

I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.

The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.

I understand that photographs or video footage may be taken during my operation.

I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements, I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.

The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.

I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

I understand that the procedure may include a blood transfusion.

I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.

The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.

I understand that photographs or video footage may be taken during my operation. These may then be used for teaching health professionals. (You will not be identified in any photo or video.)

I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,

I REQUEST TO HAVE THE PROCEDURE.
Name of Patient
Signature_________________________________
Date _____________________________________

DOCTOR’S STATEMENT
I have explained: the patient’s condition, the need for treatment, the procedure and the risks, relevant treatment options and their risks likely consequences if those risks occur, the significant risks and problems specific to this patient. I have given the patient/ substitute decision-maker an opportunity to ask questions about any of the above matters and raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.

Name of Doctor___________________________________
Signature________________________________________
Date ____________________________________________

PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY
To diminish risk of bleeding please stop all aspirin; motrin; advil; coumadin; plavix; and all non prescription dietary supplements one (1) week prior to and after the procedure

  1. The office may ask you to have blood tests done several days before your procedure. This is important to ensure that everything is optimal for your anesthetic. Occasionally, no blood testing is needed.
  2. We ask that you do not eat or drink anything after midnight on the evening prior to your operation. Food or liquid in the stomach may cause problems with the anesthetic or force your surgery to be postponed.
  3. We ask that you take two (2) Fleet’s enemas approximately 1 hour before you leave to go to the hospital on the morning of your procedure. This helps clear the rectal area of fecal material and allows for a safer and more comfortable operative procedure. Please read the instructions on the box prior to administering the enemas. Call the office if you have any questions.
  4. There are several items available in any drug store which you may find helpful to obtain and have at home for use after surgery:
    1. 4×4 gauze or other absorbent pads
    2. Stool bulking agent (Benefiber, Metamucil, Fibercon, Citrucel, etc) Stool softener (Colace, Surfak, etc)
    3. Any medications for which you were given a prescription
  5. Following these recommendations will facilitate the operative procedure and postoperative recovery.

DISCHARGE INSTRUCTIONS AFTER FISTULOTOMY
An anal fistula is an abnormal channel or tunnel-like chronic infection that starts inside the anus and ends outside on the skin around the anus. Its development is usually the result of a previous anal infection or abscess. About 50% of people with an anal abscess end up with a fistula. Most fistulas are short and superficial and are best treated by simply opening the entire tunnel and leaving it open to heal in gradually. Occasionally a patient can have a complex fistula with multiple tracts or the tunnel may traverse a considerable amount of the sphincter muscle. For this reason the surgical treatment has to be individualized for each particular patient depending on the location and anatomy of the fistula. Frequently, the surgeon cannot guarantee exactly what will need to be done until the examination that is done under anesthesia at the time of the surgery. It is important to realize that the operative procedure can change depending on what is found at the time of the surgery. At times a fistula will require more than one surgery to cure.

During a simple fistulotomy the tract is opened and left to heal. Sutures are sometimes used to narrow the wound but not close it completely. If it is decided that the fistula is too deep or in a bad position to open it completely, a small drain- called a seton – may be inserted. Your surgeon will explain how this will be managed in the future.

Discharge instructions:
Following your fistulotomy, you may experience some mild to moderate pain or discomfort in your rectal area. You may also experience constipation, difficulty urinating, and possibly some rectal bleeding. The following are some general guidelines for proper care after your procedure.

Home Care:
A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. When there is no longer any bleeding or discharge, there is no need to keep the pad in place. If there is prolonged or profuse bleeding with passage of clots, call the office at once.

Difficulty urinating after fistulotomy is unusual, but can occur due to spasm of the urinary sphincter resulting from pain due to the surgery. Getting the pain under control and relaxing the sphincter usually allows for the urine to pass. Take the pain medication you were prescribed and do warm sitz baths – either in a bath tub or sitz basin. While soaking, attempt to relax the bladder and urinate into the water. If you are unable to urinate in the first eight hours after your surgery, notify the doctor’s office. After hours, go to the nearest emergency room or urgent care center. A bladder catheter will be placed and remain in place for 2 days, you may call the office to have the catheter removed. Once you have started to urinate, drink plenty of water and fruit juices (such as prune juice) after your surgery.

You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. After a day or two, if the pain is subsiding try to use just plain Tylenol to ease residual discomfort. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.

Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well being after taking opioid analgesics. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.

  • Avoid strenuous activity for 1 week after your procedure.
  • Take sitz baths (sit for 15-20 minutes in warm water) three times a day and after
    each bowel movement for the first few days.
  • If you were given a topical ointment, place this over the anal skin and a little into the
    anal canal 2-3 times a day.
  • Don’t worry if you have some bleeding, discharge, or itching during your recovery.
    This is normal.
  • Avoid constipation.
    • Take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
    • If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
    • The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
    • If you were given a prescription for an ointment, apply this two or three times a day at the edge of the anal opening.
  • Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of
    water a day.
  • Call the office if your temperature is greater than 101 degrees.

Follow-Up
Make a follow-up appointment as directed by our staff. The first follow up is usually 3 weeks following surgery, but if a seton was placed the surgeon may want to see you sooner.

Pilonidal Cyst Surgery

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Consent Form For Pilonidal Cystectomy

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
PILONIDAL CYST

The following procedure will be performed:
Removal of a sinus (track) between the buttocks

There are some general risks and complications of the procedure, which include:
(a) Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
(b) Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
(c) A heart attack because of strain on the heart or a stroke.
(d) Death is possible due to the procedure.
There are specific risks and complications of the procedure which include:
The wound may need to be left open and packed regularly until it heals and this could be several weeks or even months.
The wound, if sutured, may break open and discharge blood or infected material. This may need further surgery.
The scar may thicken and redden and be painful.
The sinus problem may recur. This may need further surgery.
Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS
The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur. The doctor has also explained relevant treatment options as well as the risks of not having the procedure.

PATIENT CONSENT
I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,
I REQUEST TO HAVE THE PROCEDURE.

Name of Patient:_______________________________________
Signature/Date__________________________________________

DOCTOR’S STATEMENT
I have explained the patient’s condition, the need for treatment, the procedure and the risks as well as all relevant treatment options and their risks, the likely consequences of those risks as well as the significant risks and problems specific to this patient.

I have given the patient/ substitute decision-maker an opportunity to ask questions about any of the above matters and raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.

Name of Doctor: Paul E. Savoca, MD, FACS, FASCRS
Signature/Date___________________________________

Discharge Instructions for Pilonidal Cystectomy

PAUL E. SAVOCA, MD, FACS, FASCRS / CHS COLORECTAL SURGERY / SAINT CATHERINE OF SIENA MEDICAL CENTER / SAINT CHARLES HOSPITAL

  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.
  • Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, consult your physician.
  • Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking prescription pain medications. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.
    • Don’t drive while you are taking narcotic pain medication.
    • Don’t lift anything heavier than 15 pounds until your doctor says it’s okay.
    • Don’t mow the lawn, use a vacuum cleaner, or do other strenuous activities until your doctor says it’s okay.
    • You may walk indoors, outdoors, up and down stairs.
    • Expect to be off from work/school for at least one to two weeks following this surgery. Your surgeon will give you more guidance on return to normal activities.
    • Avoid constipation:
      • Eat fruits, vegetables, and whole grains.
      • Drink 6–8 glasses of water a day, unless otherwise instructed.
      • Use a fiber supplement and a stool softener twice a day. This is particularly true while taking narcotic pain medications.

Wound Care:
For comfort take pain medication prior to dressing change. The basic principle is to shower the wound twice a day and reinsert a fresh gauze in the wound after each shower.

  • Leave the dressing from surgery in place until the day after surgery.
  • The morning after surgery, remove the tape and outer dressing from the wound, getting in the shower and allow the rest of the dressing that is packed in the wound to be soaked with water and then pull it out. Unfortunately, this does hurt a bit.
  • When the dressing is removed, you may see a small amount of bleeding. This is normal.
  • Vigorously irrigate your wound in the shower for 5-10 minutes, using a hand-held shower head, it you have one. Aim showerhead directly at the wound. Bending forward helps open the wound. Let the water clean the area thoroughly.
  • Wrap a thin, clean wash cloth or 4×4 plain cotton gauze around your finger and clean gently, but thoroughly, the inner surface of the wound, removing any surface covering to expose clean, healthy pink tissue. Don’t scrub.
  • After shower, pat the skin around the wound edges dry.
  • The repacking of the wound is what usually requires help from another person. Wash hands. You may use gloves, but this is not necessary.
  • Moisten a fresh 4×4 inch plain cotton gauze with tap water. Squeeze out excess water.
    (The dressing should be damp, not wet).
  • Pack the wound gently but not tightly with the moist gauze. Use a Q-tip or your finger to ensure that the gauze reaches the bottom of the wound and place it so that all inner wound surfaces are in contact with the moist gauze.
  • Cover with a dry outer dressing and secure with tape or elastic bandage.
  • Dispose of the old dressing in plastic trash bag with twist tie.
  • As your wound heals, it will close from the bottom and sides, and you will need less and less gauze to pack it.
  • Shave the skin at least 2 inches around the wound at least once weekly. Use adhesive tape to pick up loose hair.

Follow up appointments are essential to ensure the wound is healing normally. The doctor will tell you how soon they need to see you back for the first follow up appointment.

When to Call Your Doctor:
Call the office if you have any of the following:

  • Excessive Bleeding
  • Increasing pain
  • Increased redness or drainage of the incision
  • Fever 100.5°F, or higher

Abscess Surgery

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Consent Form For Drainage Of Peri-rectal Abscess

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
Infection in the rectal area (perirectal/perianal/ischiorectal abscess)

The following procedure will be performed:
Surgical drainage of an infection (abscess) around the anus

As with any surgical procedure, there are associated risks. They include:

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
  • A heart attack because of strain on the heart or a stroke.
  • Heavy bleeding may occur from the wound. This may require further surgery and rarely a blood transfusion
  • The abscess may recur or a fistula may develop. This may require further surgery.
  • Further drainage may be necessary to open up other areas of infection. The wound may be thick or reddened as healing occurs, and may be painful.
  • Increased risk in obese people of wound infection

I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.

The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.

I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

I understand that the procedure may include a blood transfusion.

I understand that a doctor other than the Attending Surgeon may assist during the procedure. I understand this could be a doctor undergoing further training.

I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.

The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.

I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements
I REQUEST TO HAVE THE PROCEDURE.
Name of Patient____________________________________________
Signature_________________________________________________
Date_____________________________________________________

PHYSICIAN’S STATEMENT
I have explained the patient’s condition need for treatment the procedure and the risks relevant treatment options and their risks likely consequences if those risks occur the significant risks and problems specific to this patient.

I have given the patient an opportunity to ask questions about any of the above matters raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.

Name of Doctor___________________________________
Signature__________________________________________
Date______________________________________________

PREOPERATIVE PREPARATION FOR ANORECTAL SURGERY
To diminish risk of bleeding please stop all aspirin; motrin; advil; coumadin; plavix; and all non prescription dietary supplements one (1) week prior to and after the procedure

1. The office may ask you to have blood tests done several days before your procedure. This is important to ensure that everything is optimal for your anesthetic. Occasionally, no blood testing is needed.
2. We ask that you do not eat or drink anything after midnight on the evening prior to your operation. Food or liquid in the stomach may cause problems with the anesthetic or force your surgery to be postponed.
3. We ask that you take two (2) Fleet’s enemas approximately 1 hour before you leave to go to the hospital on the morning of your procedure. This helps clear the rectal area of fecal material and allows for a safer and more comfortable operative procedure. Please read the instructions on the box prior to administering the enemas. Call the office if you have any questions.
4. There are several items available in any drug store which you may find helpful to obtain and have at home for use after surgery:

  • 4×4 gauze or other absorbent pads
  • Stool bulking agent (Benefiber, Metamucil, Fibercon, Citrucel, etc)
  • Stool softener (Colace, Surfak, etc)
  • Any medications for which you were given a prescription

5. Following these recommendations will facilitate the operative procedure and postoperative recovery.

DISCHARGE INSTRUCTIONS FOLLOWING DRAINAGE OF PERIRECTAL ABSCESS
An abscess around the anus develops as a result of an infection in glands within the anal canal. Although this infection usually does not become serious, occasionally it may reach the deeper tissues surrounding the anus. This results in the formation of a painful collection of fluid and pus. An incision and drainage of the infected fluid can relieve this pain. The wound that is made is left open to allow any residual pus to drain. Sometimes a dressing is placed in the wound as well.

Following the drainage of an abscess, there is approximately a 50-50 chance for the further development of a fistula. A fistula is a tunnel beneath the skin that starts at the gland which caused the infection and runs to the area of the abscess and then out onto the anal skin. This causes persistent drainage. A fistula may result in the development of further abscesses in the future. It is therefore imperative that patients follow up with their surgeon following drainage of their abscess.

HOME CARE:
A dressing has been placed over the wound. This should be left in place until you take your first tub bath (sitz bath). This may be in the evening or next morning following your surgery. Your surgeon will tell you the timing. At whichever time you are directed, the outer dressing should be removed. There is usually a dressing in the wound and this should be soaked and then pulled out while sitting in a tub of very warm water. You should then continue to take sitz baths with warm water three times a day for 10-15 minutes.

Your wound may continue to drain a large amount over the next several days as the infection slowly heals. Wear a gauze dressing to the wound to protect your clothing. You may also use a sanitary napkin for further protection of your clothing. You may notice bloody discharge for the next four to seven days.

Patients have much less pain after the surgery than they had prior to the surgery. However, depending on the size of the abscess there may be residual discomfort for a few days. Pain should slowly decrease. After a few days if there is a change in course and pain begins to intensify call the office. You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. After a day or two, if the pain is subsiding try to use just plain Tylenol to ease residual discomfort. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.

Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed.

Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking opioid analgesics. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.

  • Avoid strenuous activity for 1 week after your procedure.
  • Take sitz baths (sit for 15-20 minutes in warm water) three times a day and after
    each bowel movement for the first few days.
  • Don’t worry if you have some bleeding, discharge, or itching during your recovery.
    This is normal.
  • Avoid constipation.
    • Take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
    • If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
    • The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
    • If you were given a prescription for an ointment, apply this two or three times a day at the edge of the anal opening.
  • Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of
    water a day.
  • Call the office if your temperature is greater than 101 degrees.

Follow-Up
Make a follow-up appointment as directed by our staff. The first follow up is usually 2 weeks following surgery.

From the Clinical Staff to All Surgical Patients:
We are here to help you with any pre-operative and post operative questions you might have. We know this is new to you and any surgery can be frightening. We are here to help you through it. Please keep the following in mind when you call:
1 – Please leave a short message as to the nature of your call. Someone will usually get back with you as soon as possible. Remember if you are having a life threatening emergency, CALL 911.
If you call after 4 PM you will receive a call back shortly after the office opens at 9 AM.
2 – Please call the office where you are seen as that location will have your medical record which will make it much easier to answer any medical questions that you have.
3 – Medication refills: Please allow 48 hours for refills. Make sure you leave the following information:
Your name – with spelling
Date of birth
Your best contact telephone number
The pharmacy telephone number (verify that it is open) the name of the medication for refill

Removal of Rectal Polyps and Tumors

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Consent Form for Trans-Anal Resection for Benign and Malignant Rectal Lesions

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
RECTAL POLYP OR TUMOR

The following Procedure will be performed:
TRANS-ANAL EXCISION (Removal of a polyp or tumor in the lower rectum via the anus)

The operation will be performed in the following manner:

  • Standard removal: polyp removal done without optical magnification using standard surgical instruments
  • Trans-anal endoscopic microsurgical removal (TEM): polyp removal utilizing a magnifying trans-anal microscope and laparoscopic instruments

SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS
The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur. The doctor has also explained relevant treatment options as well as the risks of not having the procedure.

There are some general risks/complications of this procedure as with any surgical procedure. They include:

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
  • A heart attack because of strain on the heart or a stroke.
  • Death is possible due to the procedure.

There are some risks/complications specific to this procedure which include:

  • Heavy rectal bleeding may occur during or after the procedure. This may require further surgery and possible blood transfusion.
  • The bowel may perforate and further surgery may be necessary.
  • All of the tumor may not be able to be removed at one sitting and further surgery may be necessary.
  • Recurrence of the tumor which may require more extensive treatment.
  • Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
  • Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.
  • There is a remote risk of the need for immediate abdominal surgery if complications arise during the polyp removal due to its size or location. A colostomy may be necessary. In most instances, discussion with the family is possible at this juncture but due to emergency circumstances this may not be possible until the surgery is completed.

PATIENT CONSENT
I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.

  • I have been given written information regarding the procedure.
  • I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
  • I understand that the procedure may include a blood transfusion.
  • I understand that a doctor other than the Attending Surgeon may be present during the procedure.
  • I understand this could be a doctor undergoing further training.
  • I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
  • The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
  • I understand that photographs or video footage maybe taken during my operation. These may then be used for teaching health professionals. You will not be identified in any photo or video
  • I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,

I REQUEST TO HAVE THE PROCEDURE
Name of Patient _______________________________________
Signature/Date ________________________________________

Doctor’s Statement
I have…

  • Explained the patient’s condition
  • Explained the need for treatment
  • Explained the procedure and the risks
  • Explained relevant treatment options and their risks likely consequences if those risks occur
  • Explained the significant risks and problems specific to this patient
  • Given the patient an opportunity to ask questions about the above matters
  • Given the patient an opportunity to raise any other concerns which I have answered as fully as possible.

I am of the opinion that the patient understood the above information.
Signature_______________________________

Paul E. Savoca, MD, FACS, FASCRS
Date___________________________________

Removal of Anal Warts

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Discharge Instructions After Removal Of Condyloma

Paul E. Savoca, MD, FACS, FASCRS

Anal warts, also known as condyloma, are growths found on the skin around the anus (rectal opening) and sometimes in the anal canal.

Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. The same type of warts may occur on the penis, scrotum, vagina or labia. The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time the virus remains in the tissues but is inactive. There are many types of human papilloma virus; some cause warts on the hands and feet and others cause genital and anal warts.

When the warts are just on the outer skin they may be able to be treated with a variety of medications applied in the office or at home. However, once the warts extend into the anal canal they need to be removed surgically. In most cases, a single treatment will not cure anal warts. Close follow-up is critical because the virus may continue to be present and cause new anal warts to form. Even after there are no visible warts, the virus may remain in the tissue. Small warts that reappear are easily treated in the office. Follow-up visits are necessary even after there are no visible warts. Visits may be necessary for up to six months. There is a possibility of serious problems if the warts are left untreated. On rare occasions, these warts can become cancerous, so it is important to keep the follow-up appointments the doctor suggests.

During the operation you have undergone the warts have been removed and the underlying surface has been burned slightly to eradicate the virus in the area.

Home Care

  • A small amount of bleeding is common following rectal surgery. A sanitary napkin or gauze may be worn over the anal opening to keep the underclothing clean. If there is prolonged or profuse bleeding with passage of clots, call the office at once.
  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.

Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, call the office for advice. Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed.

Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well- being after taking opioid analgesics. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.

  • If you were given a topical ointment place a thin layer over the anal wounds after baths and bowel movements.
  • Avoid strenuous activity for 1-2 weeks after your procedure.
  • Ask someone to drive you to appointments until you are able to sit and move comfortably.
  • Take sitz baths (sit for 15-20 minutes in warm water) at least 3 times a day and after each bowel movement.
  • Don’t worry if you have some bleeding, discharge, or itching during your recovery. This is normal.
  • Avoid constipation.
    • Take Benefiber or other psyllium product (Metamucil, Citrucel, Konsyl, etc) one teaspoon twice a day. Take a stool softener such as Colace or Surfak twice a day as well.
    • If you have not had a bowel movement by the morning of the fourth day following surgery, take 2 fleet enemas, 1 hour apart (lubricate the tip of the enema well with Vaseline and insert gently). If no result, drink one bottle of citrate of magnesium, which can be purchased at any pharmacy. Following the first bowel movement, you should have a bowel movement at least every other day. If 2 days pass without a bowel movement, take an ounce of milk of magnesia. Repeat in 6 hours if no result.
    • The use of dry toilet tissue should be avoided. After bowel movements use a wet Kleenex, cotton or Tuck’s pads to clean yourself, or if possible, take a warm bath.
  • Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of water a day.
  • Call the office if your temperature is greater than 101 degrees.

Follow-Up
Make a follow-up appointment as directed by our staff. The first follow up is usually 3 weeks following surgery.