As a result of the examinations and tests performed on me, my doctors, who diagnosed me as “HEMOROID (HEMOROID (HEMAUR or BREAST OCCURATION) IN BREAK)”,’ suggested “HEMOROID SURGERY” for my treatment. It is your most natural right to be informed about the medical / surgical treatment and diagnostic procedures recommended to you for the treatment of your medical condition and disease. After learning the benefits and possible risks of medical treatment and surgical interventions, it is up to you to consent or not to the procedure. In the light of this information, it will be appropriate for you to decide about your treatment with your free will. You can withdraw from your treatment decision at any time. The purpose of this statement is not to scare or worry you, but to involve you more consciously in decisions about your health..
This form has been prepared to help the physician following you to inform you about the risks of the planned treatment/intervention and alternative treatment methods. Please read this form completely and carefully and sign this consent form after you have read the form and all your doubts about the relevant procedure have been cleared by the physician. Information was also given about other health institutions that can perform this surgery..
What you need to know about your disease: In every healthy person, there are pads in the breech region, just above the toothed line (linea dentata), and they contain veins, connective tissue and smooth muscle. However, due to constant constipation or diarrhea, excessive straining, wrong toilet habits or pregnancy, these pillows turn into hemorrhoids. Hemorrhoids can also be defined as the enlargement or varicose veins of the veins in the breech (anus and rectum) region. Hemorrhoids or hemorrhoids can be found in one out of every two people around the age of 50. It is divided into internal hemorrhoids and external hemorrhoids. In the transition region of the anus from the skin to the cells of the large intestine, those on the upper part of the line called the toothed line are called internal hemorrhoids, and those in the lower part are called external hemorrhoids.
What can happen if no intervention is made?: In the absence of treatment for hemorrhoids, hemorrhoids (hemorrhoids) coagulation or other names hemorrhoids (hemorrhoids) thrombosis, perianal thrombosis, perianal hematoma, external (external) thrombosed hemorrhoids occur due to blood clotting in the vessels forming the hemorrhoid. The hemorrhoidal nozzle, which is clogged due to clots, is stretched and causes severe pain to the patient. Choking or strangulation of hemorrhoids (hemorrhoids) may occur. Hemorrhoids are a serious problem in 10-15% of women during pregnancy or pregnancy. That’s why it’s helpful for people with hemorrhoids to get proper treatment before getting pregnant. In the presence of liver cirrhosis, it can be a symptom of diseases such as portal hypertension, rectal cancer, bowel cancer, rectal cancer.
What kind of treatment/intervention will be performed (includes information on alternative treatments): Classical surgical techniques: Milligan & Morgan (open technique defined in 1937), Ferguson (closed technique), Parks (submucosal hemorrhoidectomy) and Whitehead surgeries: In principle, hemorrhoid breasts; scissors, blades, monopolar electrocautery, bipolar cautery (BICAP), “Ligasure” or “Ultracision-harmonic scalpel” type veins that can disable vessels up to 7 mm in diameter, are aimed to be cut with vein closure devices or laser. This technique is called “hemorrhoidectomy”. Anus enlargement or ‘anal dilatation’ during the procedure provides significant relief, especially in third-degree hemorrhoids. If hemorrhoids are taken from inside the breech canal of the breasts, it is called “closed hemorrhoidectomy” and there is no scar or scar on the breech skin in this technique. The process of removing the hemorrhoids from the breech skin and outside the breech canal is called “open hemorrhoidectomy”. Lateral internal sphincterotomy can be added: This is the process of cutting the internal breech muscle in order to reduce the intra-breech pressure. In the first month after the operation, 30% gas and stool or gas incontinence (incontinence) complications can be seen in 30% and 0-15% in the late period.
Laser method, ligation of the hemorrhoid artery (HAB) and LONGO method are other types of surgery. The types of surgery performed by centers and doctors may be different. You can get information about the type of surgery from your doctor.
Common side effects-complications:
1. As with any surgery, general anesthesia can have complications. During the operation, the patient will be given anesthesia and a tube will be placed in the trachea and breathing will be provided from there. Removal of the tube after this procedure may be delayed or not possible. In this case, the patient is treated in the intensive care unit. Again, the risk of death may be less than 1 in 1000 as a result of complications related to anesthesia. Detailed information about the complications related to anesthesia will be obtained from the anesthesia team and the responsibility for these matters belongs to the anesthesia team.
2. Clots that may form in the deep veins system during and after the surgery can break off from there and cause a clot to the lungs (embolism). Since the risk of embolism is practically non-existent in this surgery, no precautions will be taken with any medication
3. Gas and/or stool incontinence: One of the muscles that contract the anus can be cut during the surgery. It is a rare complication of hemorrhoid surgery (if sphincterotomy is performed) or when the cushions surrounding the anus (anal cushions) are removed excessively. There is a risk of temporary (several weeks) mild gas and/or stool incontinence around 20%, and permanent incontinence around 1-2%.
4. Infection can develop at the operative site and in the worst case lead to extensive Fournier’s gangrene and death. A colostomy or ileostomy may be required. Breech functions may be permanently lost. These risks are well below 1%.
5. This disease may recur. Re-operation may be required.
6. The development of rectal stenosis: It is one of the most important complications after hemorrhoid surgeries and is seen in 2-4%. In advanced stage complicated hemorrhoids, 5-10% rectal stenosis develops. Repeated surgeries may be required.
7.After the operation, severe pain, discharge, and wetting may occur in the anus region.
8. Bleeding from the rectum: Bleeding occurs in 2% of cases after classical hemorrhoid surgeries and in 5% of cases after Longo surgery.
9. Remaining breasts: The most common problem that patients complain about is that they interpret small skin protrusions as hemorrhoid breasts. These cause discomfort and itching to the patient.
10. Constipation may occur after the operation.
11. Continuation of breech sagging after surgery: If sufficient tissue is not removed after hemorrhoid surgery, a swelling that protrudes from the breech and causes wetting in underwear and itching in the anus remains. It was determined that sagging continued at an average rate of 13% in the Milligan & Morgan technique, 10% in the HAB technique, and 12% in the Longo technique.
12. Anus crack (anal fissure): Anus crack (anal fissure) may develop after hemorrhoids (hemorrhoid) surgery. In particular, 0.2% breech cracks are seen after Longo surgery due to the local impact (trauma) created by the stapler device. Similarly, breech cracks are encountered at a rate of 0.5% after the HAB technique.
13.Breech fistula: In less than 1% of hemorrhoid (hemorrhoid) surgeries, breech fistula (breech fistula) may develop.
14.Infection: Surprisingly, infection is very rare after hemorrhoid surgeries.
15. Itching in the rectum: It is seen after excessive cleaning of the breech area and especially after the application of soap or detergent.
16. Coagulation in hemorrhoids: 1-6% of hemorrhoidal coagulation (thrombosed hemorrhoids) may develop in hemorrhoid disease.
17. Stool grinding: After hemorrhoid surgeries, fecal hardening or ‘fecal impaction’ is observed at a rate of 1-6%.
18. Rectovaginal fistula: After hemorrhoid surgeries, a joint may develop between the part of the large intestine near the anus called the rectum and the female organ (vagina) at a rate of 0.2%, and stool may come from the female organ. May need repeat surgery.
19. Constant straining sensation (tenesmus): Feeling of defecation, which can last for 1-6 months on average, due to the staples placed in 25-30% of patients who underwent Longo surgery due to hemorrhoids and shortening of the sagging connective tissue of the anus, foreign body sensation in the anus There may be complaints such as a feeling of incomplete stool and restlessness in the anus.
The points that the patient should pay attention to before the intervention: Following your admission to the clinic, your file will be prepared by your doctors and, if necessary, you will be examined again. In the meantime, please answer the questions asked by your doctor completely. The anesthesiologist will give you a separate form like this one about which method will be applied and their risks. In terms of anesthesia, the points you need to pay attention to before, during and immediately after the operation will be explained to you by the anesthesiologists. You must not have taken solid food by mouth for at least 6 hours before the operation. It is expected from you to inform your doctor about the drugs you use (especially those that prevent blood clotting such as aspirin), your current or past important diseases and your allergy situation, It is to make your toilet before going to the operating room and to remove all metal and other jewelry and materials on you when going to the surgery. After the surgery decision is made, you will be taken into surgery according to the availability of the operating room. You can wait in your clinic for a while.
The points that the patient should pay attention to after the intervention: Immediately after the operation, you will stay in the operating room and recovery room for a while. Explanations about these points will be made by anesthesiologists. You will not feel the need to eat immediately after the surgery. Appropriate medications will be given by your doctors for your pain and other needs. Please do not use any medicine other than what your doctor and nurse give you. You can apply to your nurse and doctor for the situations that you have in mind. Your doctor will tell you when you can take liquid and solid food based on your examination and other findings. In the postoperative period, you should get up and walk around and do breathing exercises as soon as your doctor and nurse allow. Your discharge day will be determined according to your condition. Before you leave the hospital, you will be told which medications you will use, when you will come for a check-up and when you will have your stitches removed. If this is not told to you, please inform your doctors.
– I was informed about my co-morbidities other than my disease. The negativities that these co-morbidities may cause me during or after the operation were explained in detail.
– I was informed about following my pathology report after the operation and applying to the polyclinic with the result.
-I was given the above detailed information about my disease and the planned intervention. , possible complications and risks were fully explained. If these develop, I have been informed that treatments including surgery may be required, but in some cases, complete cure or recovery cannot be achieved.
-All my hospital data and records; I consent to my blood and tissue samples being used for scientific studies.
– I accept the implementation of the above-mentioned intervention and other additional interventions that may be required as a medical necessity during the intervention. I will not resort to legal action due to the complications that develop due to the surgery, provided that the above-mentioned disease and the treatment-specific acceptable complications are not excluded.
– I accept all of the medical and surgical procedures to be applied for my treatment, of my own free will, without any pressure or coercion.
– My doctor explained to me why the intended treatment is needed, the risks involved, undesirable results (complications), unexpected situations and problems that may occur, changes that may occur during my treatment and events that may occur during my recovery, and I accept these. In addition, we talked with my doctor about the examination/medical intervention/treatment/surgery and anesthesia options, benefits, undesirable results, risks, unexpected situations and events that could occur if I did not receive treatment, my questions were answered adequately and I was given sufficient information on these issues. In case my doctor finds or develops something that cannot be detected beforehand during or after the examination/medical intervention/treatment/surgery and anesthesia procedures, I allow additional or different examinations/medical interventions/treatments/surgeries and anesthesia applications that my doctor decides will be beneficial for me, and consultations that my doctor deems necessary. I accept that this treatment and the examination/intervention/treatment/surgery and anesthesia procedures to be applied are done with the aim of improving my health, but this result cannot be guaranteed and I accept unexpected situations, undesirable results and risks that may occur.
During the examination/medical intervention/treatment/surgery and anesthesia procedures, my doctor can be assisted (assisted-support-co-worked) by other physicians, nurses, health officers, technicians, health workers, trainee doctors, interns and health education recipients. I have been informed that people can also take part and I accept.
Except for the cases that are legally obligatory and the negative consequences that may arise, on my own; We were told that I have the right to refuse or stop the examination/medical intervention/treatment/surgery and anesthesia procedures that are planned or applied, and that if I refuse or stop these procedures, the consequences that will arise as a result of being left without treatment.
(Only for female patients) If I am pregnant, I have been informed that my unborn child carries a risk during examination/medical intervention/treatment/surgery and anesthesia procedures, primarily radiological procedures. I do not have a missed period or pregnancy.
PATIENT’S CONSENT
I was given the above detailed information about my disease and the planned intervention, and the possible complications and risks were fully explained. I was informed that if these develop, treatments, including surgery, may be required, but in some cases, complete cure or recovery cannot be achieved. I accept the implementation of the above-mentioned intervention and other additional interventions that may be required as a medical necessity during the intervention.
to this section;
The statement “I READ, I UNDERSTOOD, I GOT A COPY” written in the patient’s or Legal Representative’s own handwriting will be written..……………………………………………………………………………………..……………………
TO BE FILLED BY THE PATIENT:
Date of Consent:……………………………
Time :………………………………………………
Signature:…………………………………………………………………………………………
Patient’s (guardian or guardian for restricted and minors) Name and surname:……………………………
TO BE FILLED BY THE DOCTOR INFORMING THE PATIENT AND TAKING THE PATIENT’S CONSENT:
Title, Name and Surname of the Physician Receiving Consent:…………………………………………………..
Signature:……………………………………………………………………………………………
TAKING MEDICAL INTERVENTION
Name Surname Title:……………………………………………………………………..
Signature:……………………………………………………………………………………