1. Preparation of patient before surgery
Jozef Rybar, MD.
IV.surgical clinic, UH, Bratislava

2. Aim / goal of preparation
Lowering the risk of surgery
Apropriate diagnosis (staging,..)
Preparing the operation field
Psychological preparation
Informed consent

3. Aim / goal of preparation
Lowering the risk of surgery
Appropriate diagnosis (staging,..)
Preparing the operation field
Psychological preparation
Informed consent

4. and risk of postoperative complications
Lowering the operation risk
and risk of postoperative complications
Estimation of risk acording to the general condition of patient
ASA classification (American Society of Anesthesiologists)
Possibly postpone surgery after myocardial infart (after 6 months risk of reinfarction significantly decreases)
Fasting before OP – risk of vomiting by induction and end of anesthesia – should be at least 6 hours
Cleaning the intestine (laxatives, enema)
For internal diseases – spirometry, Echocardiography, ECG

5. Apropriate diagnosis
By tumours – staging/histology ---> radicality + neoadjuvant therapy (lymphadenectomy, radio or chemotherapy..)
Ileus - Paralytic vs. Mechanical -physical examination, abdominal x-rays with contrast fluid (by paralytic it should be moving with time further), possibly abdominal CT
Acute appendicitis – gynaecological examination (possibly adnexitis, ruptured ovarian cyst)
Cholecystectomy – choledocholithiasis –
USG, MRCP, in case it is diagnosed, ERCP should be performed before cholecystectomy
Varicectomy – deep vein trombosis
needs to be excluded by Doppler ultrasound

6. Preparing the operation field
Shaving the area of operation
Antisepsis – antiseptic fluid right before surgery
Covering the surrounding skin

7. Psychological preparation
Education of the patient about preoperative phase (possibly also family member)
Explanation of the surgical procedure
Mention possible complications
Informed consent