v6.00 Clinical content review: 2011 DO NOT WRITE IN THIS BINDING MARGIN © The State of Queensland (Queensland Health) 2021 Except as permitted under the Copyright Act 1968, no part of this work may be Clinical check: 01/2021 reproduced communicated or adapted without permission from Queensland Health SW9084 Published: 01/2021 To request permission email: [email protected] the patientinformationsheet): (Doctor/clinician todocumentadditionalrisksnotincludedin abdominoperineal resectionofrectum D. Risksspecifictothepatientinhavingan Abdominoperineal resectionofrectum following procedure(s) C. Patient/substitutedecision-makerrequeststhe Interpreter code: Name ofinterpreter: If B. Isaninterpreterrequired? Category ofsubstitutedecision-maker: Name ofsubstitutedecision-maker: 3. StatutoryHealth Attorney. appointed guardian;2.EnduringPowerof Attorney; or decision-maker inthefollowingorder:Category1. Tribunal- or ifthereisno AHD, theconsentobtainedfromasubstitute You mustadheretothe Advance HealthDirective(AHD), A. Doesthepatienthavecapacity? Facility: yes translatedtheinformedconsentformovertelephone  No Yes in person provided asighttranslationoftheinformedconsentform Abdominoperineal Resection , theinterpreterhas: è è COMPLETE GOTO ...... of RectumConsent Adult (18yearsandover) sectionB section A

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Date ofbirth: Address: Given name(s): Family name: URN:

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abdominoperineal resectionofrectum): (Doctor/clinician todocumentspecificrisksinnothavinga abdominoperineal resectionofrectum E. Risksspecifictothepatientin Signature: Designation: Name ofdoctor/clinician: information hasbeenunderstood. the contentsofthisformandamopinionthat I haveexplainedtothepatient/substitutedecision-maker clinician andthepatient/substitutedecision-maker. a substitutefordirectcommunicationbetweenthedoctor/ The informationinthisconsentformisnotintendedtobe G. Informationforthedoctor/clinician included inthepatientinformationsheet): (Doctor/clinician todocumentalternativetreatmentnot F. Alternative treatmentoptions (Affix identificationlabelhere) Sex: not

M Date: havingan F

I ABDOMINOPERINEAL RESECTION OF CONSENT RECTUM OF RESECTION ABDOMINOPERINEAL

(Affix identification label here)

URN:

Family name: Abdominoperineal Resection of Rectum Consent Given name(s): , no part of this work may be Adult (18 years and over) Address:

Date of birth: Sex: M F I Copyright Act 1968 H. Patient/substitute decision-maker consent 2) Student examination/procedure for professional training purposes: The State of Queensland (Queensland Health) 2021 © I acknowledge that the doctor/clinician has explained: request permission email: [email protected] To • the “Abdominoperineal resection of rectum” patient For the purpose of undertaking training, a clinical student(s) information sheet may observe medical examination(s) or procedure(s) and • the medical condition and proposed treatment, including the may also, subject to patient/substitute decision-maker possibility of additional treatment consent, assist with/conduct an examination or procedure Except as permitted under the • the specific risks and benefits of the procedure on a patient while the patient is under anaesthetic. reproduced communicated or adapted without permission from Queensland Health • the prognosis, and risks of not having the procedure I/substitute decision-maker consent to a clinical student(s) • alternative treatment options undergoing training to: • that there is no guarantee the procedure will improve the • observe examination(s)/procedure(s) Yes No medical condition • assist with examination(s)/procedure(s) Yes No • that the procedure may involve a blood transfusion • conduct examination(s)/procedure(s) Yes No • that tissues/blood may be removed and used for diagnosis/ management of the condition • that if a life-threatening event occurs during , I will be treated based on documented discussions (e.g. AHD or ARP [Acute Resuscitation Plan]) • that a doctor/clinician other than the consultant/specialist may assist with/conduct the clinically appropriate procedure/ treatment/investigation/examination; this may include a doctor/clinician undergoing further training under supervision • that if the doctor/clinician wishes to record video, audio or images during the procedure where the recording is not required as part of the treatment (e.g. for training or research purposes), I will be asked to sign a separate consent form. If I choose not to consent, it will not adversely affect my access, outcome or rights to medical treatment in any way. I was able to ask questions and raise concerns with the doctor/clinician. I understand I have the right to change my mind regarding consent at any time, including after signing this form (this should be in consultation with the doctor/clinician). DO NOT WRITE IN THIS BINDING MARGIN WRITE IN DO NOT I/substitute decision-maker have received the following consent and patient information sheet(s): “Abdominoperineal resection of rectum” “About your anaesthetic” “Epidural and spinal anaesthesia” “Fresh blood and blood products transfusion” On the basis of the above statements, 1) I/substitute decision-maker consent to having an abdominoperineal resection of rectum. Name of patient/substitute decision-maker:

Signature: Date:

Page 2 of 7 © The State of Queensland (Queensland Health) 2021 Except as permitted under the Copyright Act 1968, no part of this work may be reproduced communicated or adapted without permission from Queensland Health DO NOT WRITE IN THIS BINDING MARGIN To request permission email: [email protected] SW9084 Abdominoperineal resection ofrectum patientinformation sheet shouldbeincludedinthepatient’s medicalrecord. allow timetoaskanyquestionsabouttheprocedure.Theconsentformandpatientinformation A copyofthisformshouldbegiventothepatient/substitutedecision-makerreadcarefullyand Adult (18yearsandover)|Informedconsent:patientinformation Abdominoperineal resectionofrectum Surgery canalsobeused asameasuretoeasesymptoms. operation. However, yourrecovery dependsonhowfarthediseasehasspread atthetimeofyour of thesurgeryistogive youthebestchanceofcurethroughtotal removal ofthetumour Removal ofthediseasedbowelisfirsttreatment foratumourofthebowel. A colostomyismade toallowwastepassthroughanopeningintheabdominalwall. made ontheoutsideofbodyforwasteto passoutofthebody If thedoctor/clinicianisnotabletojoinbowel backtogether The healthypartsofthebowelarethenstitched orstapledtogether(anastomosis). normal boweloneithersideofthetumour(as wellasnearbylymphnodes)areremoved. Surgery isthemaintreatmentfortumoursof thebowel.Usually, thetumourandalengthof grow throughsomeoralloftheotherlayers. Tumours startintheinnermostlayerandcan in anyoftheseareasorthebackpassage. colon andthesigmoidcolon. Tumours canstart colon, thetransversedescending The bowelhasfoursections:theascending a tumour(agrowthofcancercells). rectum maybegintogrowoutofcontrol,forming passage (anus).Cellsthatlinethecolonand of itaswastethroughtheopeningtoback digested foodfromthesmallbowelandgetsrid of thedigestivetractcarriesremains colon andrectum(backpassage). This part The largebowel(intestine)ismadeupofthe worn overthecolostomy. and allowsthebowelcontenttodrainintoabag the abdomenasacolostomy. This ispermanent large bowelisbroughtoutthroughthewallof will remainpermanentlyclosed. The endofthe genitals). The analareaisstitchedtogetherand perineum (theskinbetweentheanusand the analregionthroughabdomenand large bowel,therectum(backpassage)and involves theremovaloflowerpart An abdominoperinealresectionoftherectum v6.00 will ithelpme/thepatient? 1. Whatisanabdominoperinealresectionofrectumandhow Clinical content review: 2011 Clinical check: 01/2021 Published: 01/2021 Illustration Copyright©2019NucleusMedicalMedia, All rights Image 1:. reserved. Illustration Copyright©2019NucleusMedicalMedia, All rights Image 2:Partsofthelargeintestine. reserved. www.nucleusmedicalmedia.com www.nucleusmedicalmedia.com , anopening(stoma)willbe . This iscalledacolostomy. The goal Page 3of7 . Types of surgery 2. What are the risks? A number of different surgical procedures are used depending on where the tumour is. There are risks and complications with this These include: procedure. There may also be risks specific • Right hemicolectomy – removal of the to each person’s individual condition and last part of the small bowel, the caecum, circumstances. Please discuss these with the and a small part of the doctor/clinician and ensure they are written . on the consent form before you sign it. Risks • Left hemicolectomy – removal of the include but are not limited to the following: and . • Sigmoid – removal of the Specific risks sigmoid colon and nearby large bowel. • leakage where the bowel was stitched together. This may need further surgery A number of different surgical procedures • bleeding into the . A blood are available to treat tumours of the back transfusion and further surgery may be passage, the choice depending on where the necessary tumour is and how far it has spread: • bowel is paralysed, causing abdominal • Low anterior Resection – used for most bloating and vomiting. This is usually tumours of the back passage, except temporary when the tumour is very close to the anal • the wound may become infected. This is muscles (sphincter). The bowel and the usually treated with antibiotics or the wound back passage are joined together so that may need to be opened the back passage is spared. • urinary tract infection. Antibiotics may be • Abdomino-perineal resection – this is used to control the infection done when the tumour is in the lowest part • infection in the abdominal cavity. This may of the back passage. The back passage form an abscess which may need drainage and the opening to the back passage are and antibiotics removed and the area is stitched up and • the bowel may be unable to be joined and will remain permanently closed. The waste may be brought to the surface as a , collects in a disposable bag (a colostomy with the following problems: bag) which is stuck over the opening. - the blood supply to the stoma may fail Preparing for the procedure and cause damage. This may need further surgery Before surgery, the bowel must be prepared - excess fluid loss from the stoma to lower the risk of infection. You may be - stoma prolapse – the bowel protrudes told to have a low fibre diet 2-3 days before past the skin surgery. You will be then be on a clear - parastomal – the bowel pushes fluid diet and given a medicated drink to through a weak point in the muscle wall, help clean the large bowel. This can cause causing pain diarrhoea and cramps, and may be tiring. - local skin irritation – reddening of the The medicated drink will completely empty skin and a rash in reaction to the stoma your bowel. bag glue • damage to the tube bringing the urine from You will then fast for at least 6–8 hours the kidney to the bladder before your surgery. If you are having a • abnormal emptying of the bladder. It may colostomy, the surgeon or a stoma nurse empty without control or may not empty will discuss with you the best site for your at all colostomy and will mark the area with a • inability to have and/ or maintain an marker pen. It is usually placed below your erection in men. In women, it can cause belt line, away from any other scars you may pain during or after intercourse have and at least 8–10 cm away from your • the wound may be thickened, red and wound, depending on your size and shape. painful

Abdominoperineal resection of rectum patient information SW9084 v6.00 Clinical content review: 2011 Clinical check: 01/2021 Published: 01/2021 Page 4 of 7 • bowel actions may be much looser after If you choose not to have the procedure, you 2. What are the risks? the operation will not be required to sign a consent form. • adhesions (bands of scar tissue) may If you have signed a consent form, you There are risks and complications with this develop in the abdominal cavity and the have the right to change your mind at procedure. There may also be risks specific bowel may block any time prior to the procedure/treatment/ to each person’s individual condition and • death as a result of this procedure is investigation/examination. Please contact the circumstances. Please discuss these with the possible. doctor/clinician to discuss. doctor/clinician and ensure they are written on the consent form before you sign it. Risks General risks include but are not limited to the following: • infection can occur, requiring antibiotics 3. Are there alternatives? and further treatment Specific risks • bleeding could occur and may require a Radiation Therapy has been used for some • leakage where the bowel was stitched return to the operating room. Bleeding is people as the main treatment for rectal together. This may need further surgery more common if you have been taking tumours but is not normally used in colon • bleeding into the abdomen. A blood blood thinning drugs, such as warfarin, tumours. transfusion and further surgery may be aspirin, clopidogrel (Plavix, Iscover, Radiation therapy is not as effective as necessary Coplavix), prasugrel (Effient), dipyridamole surgery for patients who could normally be • bowel is paralysed, causing abdominal (Persantin or Asasantin), ticagrelor treated by bowel removal. bloating and vomiting. This is usually (Brilinta), apixaban (Eliquis), dabigatran temporary (Pradaxa), rivaroxaban (Xarelto) or Chemotherapy (use of drugs to treat tumour) • the wound may become infected. This is complementary/alternative medicines, such is usually used together with surgical usually treated with antibiotics or the wound as fish oil and turmeric removal and may not be offered as the only may need to be opened • small areas of the lung can collapse, treatment. • urinary tract infection. Antibiotics may be increasing the risk of chest infection. This used to control the infection may need antibiotics and physiotherapy 4. What should I expect • infection in the abdominal cavity. This may • increased risk in obese people of wound after the procedure? form an abscess which may need drainage infection, chest infection, heart and lung After the operation the nursing staff will and antibiotics complications, and thrombosis • the bowel may be unable to be joined and closely watch you until you have recovered • heart attack or stroke could occur due to from the anaesthetic. may be brought to the surface as a stoma, the strain on the heart with the following problems: • blood clot in the leg (DVT) causing pain You may even be cared for in the intensive - the blood supply to the stoma may fail and swelling. In rare cases part of the clot care unit immediately following your surgery. and cause damage. This may need may break off and go to the lungs. further surgery The recovery period after colon surgery - excess fluid loss from the stoma This procedure will require an anaesthetic. varies. It usually involves a stay in the - stoma prolapse – the bowel protrudes hospital from 3–10 days in uncomplicated For more information about the anaesthetic past the skin cases. On return from your surgery you will and the risks involved, please refer to the have a catheter (plastic tube) in the bladder - parastomal hernia – the bowel pushes anaesthetic information sheet that has been to measure and drain your urine. through a weak point in the muscle wall, provided to you. Discuss any concerns with causing pain After surgery you will be given intravenous the doctor/clinician. - local skin irritation – reddening of the fluids (a drip) through which antibiotics may skin and a rash in reaction to the stoma If you have not been given an anaesthetic be given. The drip will remain in place until bag glue information sheet, please ask for one. you are able to drink enough fluids. • damage to the tube bringing the urine from Diet the kidney to the bladder What are the risks of not having • abnormal emptying of the bladder. It may an abdominoperineal resection of During the first few days of recovery, you will empty without control or may not empty rectum? not be able to eat until the bowel has begun to work again. at all Symptoms including pain and bleeding • inability to have and/ or maintain an may become worse and your bowel may You know the bowel has started to work erection in men. In women, it can cause completely block or burst. again when you pass wind and/or have a pain during or after intercourse bowel movement. You will then begin to take • the wound may be thickened, red and Without surgery, the disease may spread to liquids by mouth and then solid food. painful other areas of your body.

Abdominoperineal resection of rectum patient information SW9084 v6.00 Clinical content review: 2011 Clinical check: 01/2021 Published: 01/2021 Page 5 of 7 Colostomy Exercise The colostomy drains bowel waste from Expect to feel tired for some time after the bowel into the colostomy bag. Most surgery. You need to take things easy and colostomy waste is softer and more liquid gradually return to normal duties, as you feel than normally passed bowel waste. able to. It usually takes at least 6 months to get over the operation. You should not drive The thickness of the bowel waste depends during the first 2–3 weeks. on where the stoma is. You will be taught how to clean around the colostomy and Do not lift heavy weights for at least six change the colostomy bag. weeks after surgery. This is to prevent a rupture where the cuts were made and allow The colostomy bag sticks to the skin around healing to take place inside. the stoma with special glue, and can be thrown away when dirty. This bag does not Tell your doctor/clinician if you have: show under clothing, and most people learn • large amounts of bloody leakage from to take care of these bags themselves. the wound • blood in your stools Wound • fever and chills Your wound will have stitches and/ or staples • pain that is not relieved by prescribed and is usually covered with a dressing, pain killers which may be adhesive plaster or a spray-on • swollen abdomen plastic covering. • swelling, tenderness, redness at or around the cut. Drain You may also have a small tube that drains 5. Who will be performing into a bag or a bottle from near your wound. This is called a drain. The wound drain the procedure? removes fluid from your wound and helps in A doctor/clinician other than the consultant/ the healing process. It is taken out when the specialist may assist with/conduct the drainage has dried up. clinically appropriate procedure/treatment/ Your lungs and blood supply investigation/examination. This could be a doctor/clinician undergoing further It is likely that on your return from surgery training, however all trainees are supervised you will be wearing elastic (anti-embolism) according to relevant professional guidelines. stockings. These are tight fitting stockings that are used to reduce the risk of blood clots If you have any concerns about which doctor/ forming in your legs. clinician will be performing the procedure, please discuss with the doctor/clinician. It is very important after surgery that you start moving as soon as possible. This helps For the purpose of undertaking professional to prevent blood clots forming in your legs training in this teaching hospital, a and possibly going to your lungs. This can clinical student(s) may observe medical be fatal. examination(s) or procedure(s) and may also, subject to your consent, assist with/ Also, you need to do your deep breathing conduct an examination or procedure on a exercises. Take ten deep breaths every patient while the patient is under anaesthetic. hour to prevent secretions in the lungs from collecting. If this happens, you may develop If you choose not to consent, it will not a chest infection. At all costs, avoid smoking adversely affect your access, outcome after surgery as this increases your risk of or rights to medical treatment in any way. chest infection. Coughing is painful after You are under no obligation to consent to abdominal surgery. an examination(s) or a procedure(s) being undertaken by a clinical student(s) for training purposes.

Abdominoperineal resection of rectum patient information SW9084 v6.00 Clinical content review: 2011 Clinical check: 01/2021 Published: 01/2021 Page 6 of 7 6. Where can I find support or more information? Hospital care: before, during and after is available on the Queensland Health website www.qld.gov.au/health/services/hospital- care/before-after where you can read about your healthcare rights. You can also see a list of blood thinning medications at www.health.qld.gov.au/ consent/bloodthinner. Staff are available to support patients’ cultural and spiritual needs. If you would like cultural or spiritual support, please discuss with your doctor/clinician. Queensland Health recognises that Aboriginal and Torres Strait Islander patients will experience the best clinical care when their culture is included during shared decision-making.

7. Questions

Please ask the doctor/clinician if you do not understand any aspect of this patient information sheet or if you have any questions about your/the patient’s medical condition, treatment options and proposed procedure/treatment/investigation/ examination.

8. Contact us

In an emergency, call Triple Zero (000). If it is not an emergency, but you have concerns, contact 13 HEALTH (13 43 25 84), 24 hours a day, 7 days a week.

© The State of Queensland (Queensland Health) 2021. Except as permitted under the Copyright Act 1968, no part of this work may be reproduced communicated or adapted without permission from Queensland Health. To request permission email: [email protected] Abdominoperineal resection of rectum patient information SW9084 v6.00 Clinical content review: 2011 Clinical check: 01/2021 Published: 01/2021 Page 7 of 7