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Umbilical Hernia Consent ReportLab

This document is an informed consent for umbilical hernia repair with repositioning of the umbilicus, detailing the procedure, risks, and alternative treatments. It emphasizes the importance of understanding the potential complications, including umbilical malposition and hernia recurrence, as well as general surgical risks. Patients are advised on pre- and post-operative care, including smoking cessation and medication disclosure, and must consent to various aspects of the procedure and documentation.

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Vinay Jacob
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We take content rights seriously. If you suspect this is your content, claim it here.
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44 views2 pages

Umbilical Hernia Consent ReportLab

This document is an informed consent for umbilical hernia repair with repositioning of the umbilicus, detailing the procedure, risks, and alternative treatments. It emphasizes the importance of understanding the potential complications, including umbilical malposition and hernia recurrence, as well as general surgical risks. Patients are advised on pre- and post-operative care, including smoking cessation and medication disclosure, and must consent to various aspects of the procedure and documentation.

Uploaded by

Vinay Jacob
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INFORMED CONSENT – UMBILICAL HERNIA REPAIR WITH REPOSITIONING OF THE UMBILICUS (LOWER A

INSTRUCTIONS
This is an informed-consent document that has been prepared to help inform you concerning umbilical hernia repai

It is important that you read this information carefully and completely. Please initial each page, indicating that you h

GENERAL INFORMATION
An umbilical hernia occurs when a portion of the abdominal contents protrudes through a weakened area in the abd

This operation is not a weight-loss procedure. Obese individuals who intend to lose weight should delay surgery un

ALTERNATIVE TREATMENTS
Alternative treatments include observation if the hernia is small and asymptomatic, or repair through a traditional op

SPECIFIC RISKS OF UMBILICAL HERNIA REPAIR WITH UMBILICAL REPOSITIONING

Umbilical Malposition: The repositioned umbilicus may appear asymmetrical, too high, too low, or distorted.

Umbilical Loss: Compromised blood supply during detachment and repositioning may result in partial or complete l

Umbilical Stenosis: The new umbilical site may heal with narrowing or may develop an unnatural shape.

Umbilical Hernia Recurrence: There is a risk of hernia recurrence, especially in cases of poor tissue quality or incre

Mesh-Related Complications: If mesh is used, there may be infection, extrusion, chronic pain, or rejection.

Seroma: Fluid accumulation in the operated area requiring drainage.

Infection: Surgical site infection may require antibiotics or further procedures.

Delayed Wound Healing: Especially in smokers, diabetics, or obese patients.

Scarring: Visible or hypertrophic scars at the lower abdomen or umbilical site.

Change in Skin Sensation: Numbness or increased sensitivity near the incision or umbilicus.

Skin Contour Irregularities: Including bulges, dimpling, or asymmetry.

Damage to Deeper Structures: Rarely, nerves or blood vessels may be injured.

Pain: Postoperative pain is expected and usually temporary.

GENERAL RISKS OF SURGERY


These include bleeding, infection, anesthetic complications, hematoma, seroma, unfavorable scarring, asymmetry,

ADDITIONAL ADVISORIES

Smoking and Nicotine Use: Increases risk of healing complications. Avoid smoking at least 6 weeks pre- and post-s

Medications and Supplements: Certain drugs and supplements increase bleeding risk. Inform your surgeon of all m

Pregnancy: Future pregnancies can alter results and may lead to recurrence.
Sun Exposure: Can lead to poor scarring or pigmentation changes. Avoid direct sun exposure on the scars.

Mental Health: Elective surgery may not solve body image issues. Patients must have realistic expectations.

RE-OPERATION
Further surgery may be necessary to correct complications or unsatisfactory outcomes.

PHOTOGRAPHY AND DOCUMENTATION


You consent to be photographed for medical, educational, or documentation purposes, with identity protected.

FINANCIAL RESPONSIBILITIES
Surgical fees do not include future procedures, revisions, or treatments needed for complications.

CONSENT FOR SURGERY / PROCEDURE or TREATMENT


1. I hereby authorize Dr. _________________________ and such assistants as may be selected to perform the fol
**Umbilical Hernia Repair with Umbilical Repositioning via Lower Abdominal Approach**

2. I recognize that during the operation, unforeseen conditions may necessitate additional procedures. I authorize t

3. I consent to anesthesia as deemed necessary. I understand all anesthesia involves risk.

4. I understand expected outcomes, limitations, risks, and possible complications. My questions have been answer

5. I consent to photography for clinical or educational use with confidentiality maintained.

6. I consent to observers in the operating room for educational purposes.

7. I consent to appropriate disposal of tissues removed.

8. I consent to use of blood products if required.

9. I understand that surgical, hospital, and anesthesia fees are separate, and additional costs may arise from comp

10. I understand not undergoing this procedure is an option.

11. IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:


a. THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN
b. THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
c. THERE ARE RISKS TO THE PROCEDURE OR TREATMENT PROPOSED

I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE LISTED ITEMS (1-11).
I AM SATISFIED WITH THE EXPLANATION.

_______________________________________________________________
Patient or Person Authorized to Sign for Patient

Date ___________________ Witness ___________________________

Patient Initials ________ Version 2025

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