GENERAL SURGERY 7. Risksbasedonthepatient’s personalclinicalcondition occur. may requireanotheroperation, insomecasesemergency procedures, and inexceptional cases death may etc.) butthey are usuallyresolvedwithmedicaltreatment(medicines, IVsolutions, These complications specific tothisprocedure,whichmaybe: common onesderivingfromanyoperation and whichmayaffect all organsandsystems,others Despitetheproperchoiceoftechniqueanditsperformance, undesirable effects may occur,both 6. Commonandinfrequentrisks ……………………………………………………………………………………………………….. If the procedure is notperformed ……… the followingmayhappen ……………………….………………………………. 5. Foreseeableconsequencesofnotperformingtheprocedure Avoid parenteralnutritionorfeedingbymeansoflong-termnasogastrictube 4. Foreseeableconsequencesoftheprocedure it necessarytoperformalaparoscopicorlaparotomicgastrostomy. difficulty usingthismethod (inability to perform endoscopy or percutaneous access to the stomach) make Typically, apercutaneous endoscopic gastrostomy isperformed. In your case, contraindications and/or 3. Reasonablealternativestothisprocedure can noteatbymouth. This techniqueisintendedtoensurethepatient’senteralnutrition,temporarilyorpermanently,whenthey 2. Purposeoftheprocedureandbenefitsthatareexpected it iswornorwhenthereaproblemmalfunction. correct use of the tube. You should know that the tube needs to be replaced with certain frequency when patient mustbe informed, by the stomal therapistoraspecialisedphysician,onthe care required for the be positionedtoneverremoved,butinthiscasethe When thegastrostomyispermanent,tubewill resumed. the medicalproblemthatrequiredgastrostomyisovercome, it canthenberemoved and oralfeedingis Gastrostomy may be temporary or permanent. When it is temporary it is because it isexpected that once them orally(iebymouth). circumstance (tumours, caustictofeed injury, trauma,intestinalmotilitydisorders...)itisimpossible an outletthroughtheabdominalwall.Itspurposeistofeed the patientwhenforanypathological Placing ofagastrostomyfeedingtubeinvolvesinsertionspecialprobeinsidethestomach,with 1. Identificationanddescriptionoftheprocedure Lung infection,bypassageofstomachcontentsintothelungs, causingaspirationpneumonia. Infections. These are quite rare, the most commonare skin infections,which respond to local treatment. Leaking of stomach contents into the abdominal cavity, causing peritonitis that might require surgery. Accumulation ofbloodintheabdominalwall(haematoma) and/or gastrointestinalhaemorrhage. The gastrostomytubemaycomeoutormove Reflux ofgastricjuicearoundtheostomy,withirritation the abdominalwall. days. Abdominal pain, malaise and fever, which are not serious and are usually resolved within two or three Gastrostomy feedingtubeorLaparotomy Basic informationsheetonLaparoscopic Basic information sheet on Laparoscopic Gastrostomy feeding tube or Laparotomy

Declaration of consent

Mr./Mrs./Miss...... , aged ...... , with home address at ...... ,...... , National Identity No...... and SIP number ......

Mr./Mrs./Miss...... , aged ...... , with home address at...... , acting in the capacity of (the patient’s legal representative, relative or close friend) ...... , with National Identity No ......

Hereby declare:

That the Doctor ...... has explained to me that it is advisable/necessary in my situation to perform a ...... , and that I have adequately understood the information he/she has given me.

In ...... on ...... , 2......

Signed: Mr./Mrs./Miss...... With National Identity Card No ......

Signed: Dr...... With National Identity Card No ......

Associate number ......

Revocation of the consent

I hereby revoke the consent granted on the date of ...... , 2...... and I do not wish to carry on with the treatment that I hereby terminate on this date.

In ...... on ...... , 2......

Signed: The Doctor ...... Signed: The patient ......

Associate number: ...... GENERAL SURGERY