Consent taking for biopsy

1. Preoperative orders and consents
for Incisional & excisional biopsy and
Pancreaticojejunostomy
Dr. Kamal Raj
JR1 , Batch 2022
Department of General surgery

2. Incisional & excisional biopsy
Preoperative orders
• Explaining about the procedure
• Getting informed operative consent
• Part preparation
• Local anaesthesia sensitivity testing
• Administering antibiotics and analgesics
• Marking the site of lesion

3. Consent for Incisional Biopsy and
excisional biopsy
• About the procedure : when the entire tumor
is removed , it is called excisional biopsy . If
only a portion of mass is removed , it is called
incisional biopsy .
• Indications : Establish diagnosis of the mass.
• Complications : pain ,infection , swelling
,bleeding , scar formation , hematoma
formation ,numbness at biopsy site .

6. Pancreaticojejunostomy
Preoperative evaluation and orders
• Goal – Reduce the patient’s surgical and anaesthetic
perioperative morbidity or mortality
• History and physical examination
• Laboratory investigations
• Explaining about the procedure
• Getting Informed Operative and High Risk/DOT consent
• Part preparation
• Nil per oral , 8 hours for solids and 6 hours for liquids
• Arranging blood and products according to patients
general condtions

7. • Bowel preparation with stimulant agents or
laxatives .
• Administration of iv antibiotics , analgesics ,
antacids , antiemetics .

8. Optimising patient’s medical
conditions
• Hypertension – Antihypertensives to be
continued till the day of surgery .
• Diabeties – OHA are withheld till the day of
surgery for an agent with short half life and upto
48 hours pre-op for long acting agents and
replaced with a combination of Insulin and
glucose .
• Epilepsy – patient with epilepsy undergoing
surgery should be kept on same antiepileptic
medication.

9. Pulmonary diseases – 4 hourly nebulisation in patient
with poor chest condition on examination and chest
radiographs .
Thyroid diseases –Thyroid medications to be continued
till the day of surgery .
Deranged coagulation profile – Antiplatelets drugs to be
stopped few days before surgery
like Aspirin 3 days before
If INR pre-op is 2-3 , stop oral anticoagulants 4 days prior
to surgery .Measure INR one day prior to surgery
If it is > 1.7 give 1 mg vitamin K SC
If it is > 1.3-1.7 adm. 1 unit of FFP
If it is > 1.7-1.2 adm. 2 unit of FFP

10. Consent for
Pancreaticojejunostomy
• About the procedure : Roux-en-y lateral
pancreaticojejunostomy(Puestow procedure)
provides pain relief through ductal drainage
while preserving pancreatic parenchyma. The
pancreatic duct is opened head to tail and the
Roux jejunal limb is sutured to the pancreatic
capsule around the filleted duct to provide
drainage route.

11. Indications:
– intractable pain resistant to conventional non
surgical therapy in chronic pancreatitis
– Patient with associated or suspected malignancy
– Patients with complications( billiary or duodenal
obstruction, pancreatic fistula, pancreatic ascites)

12. Complications :
– Bleeding
– Infection/intrabdominal abcess
– injury to intrapancreatic portion of bile duct
– anastomotic leak
– billiary obstruction
– recurrence
– Prolonged ileus
– stricture formation
– Steatorrhoea
– Diabetic like condition
– adhesions .