ARTP Form

Specialty: Surgeon **ARTP Form** **1. Patient Demographics:** * **Patient Name:** [Not Applicable - This section is typically pre-populated from the patient record, but for this example, we will assume it is automatically pulled. However, if manually entering, it would be 'John Smith'] * **Date of Birth:** [Not Applicable - This section is typically pre-populated from the patient record, but for this example, we will assume it is automatically pulled. However, if manually entering, it would be '15/03/1970'] * **Hospital Number:** [Not Applicable - This section is typically pre-populated from the patient record, but for this example, we will assume it is automatically pulled. However, if manually entering, it would be 'HOSP1234567'] **2. Date of Consultation/Procedure:** 1 November 2024 **3. Referring Physician:** Dr. Sarah Jenkins **4. Indication for Referral/Procedure:** Right inguinal hernia, causing intermittent discomfort and a palpable bulge, impacting daily activities and exercise. Patient requests definitive repair. **5. Pre-operative Assessment:** * **Past Medical History:** Hypertension (well-controlled with medication), mild asthma (no recent exacerbations). * **Past Surgical History:** Appendicectomy (1995), Tonsillectomy (1980). * **Medications:** Ramipril 5mg OD, Salbutamol inhaler PRN. * **Allergies:** Penicillin (rash). * **Social History:** Non-smoker, occasional alcohol, works as an accountant. * **Physical Examination Findings:** Right groin reveals a reducible, non-tender bulge on coughing, consistent with an inguinal hernia. No evidence of strangulation. Left groin unremarkable. Cardiovascular and respiratory examinations normal. **6. Proposed Procedure:** Laparoscopic Inguinal Hernia Repair (TAPP) with mesh placement on the right side. **7. Risks Discussed with Patient:** * **General Surgical Risks:** Bleeding, infection, pain, anaesthetic risks (nausea, vomiting, allergic reaction, cardiac event), DVT/PE, scar formation, nerve damage. * **Specific Risks of Inguinal Hernia Repair:** Recurrence (approx. 1-5%), chronic groin pain (neuropathic or mesh-related, approx. 1-10%), seroma/haematoma formation, testicular injury/atrophy (rare), bowel/bladder injury (rare), mesh infection (rare, requiring removal). **8. Benefits of Proposed Procedure:** Resolution of hernia symptoms, reduction of discomfort, improved quality of life, prevention of potential complications (incarceration/strangulation). **9. Alternatives Discussed:** * **Watchful Waiting:** Not recommended due to progressive symptoms and patient's desire for repair. * **Open Inguinal Hernia Repair:** Discussed as an alternative, but laparoscopic approach preferred due to patient's fitness, smaller incisions, and faster recovery. **10. Patient Understanding and Consent:** * Patient verbally confirmed understanding of the proposed procedure, its risks, benefits, and alternatives. * Patient expressed no further questions and provided informed consent for the laparoscopic inguinal hernia repair. * Consent form signed and dated. **11. Surgeon's Signature:** Dr. Thomas Kelly **12. Date:** 1 November 2024 **13. Review Date/Follow-up Plan:** Follow-up in clinic 2 weeks post-operatively for wound check and review of recovery. Patient advised to contact clinic sooner if any concerns arise.