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Consent: Diagnostic (Exploratory) Laparoscopy

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Last updated: March 12, 2021
Revisions: 8

Last updated: March 12, 2021
Revisions: 8

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A diagnostic laparoscopy is a minimally invasive procedure that allows direct visualisation of the intra-abdominal organs.

It is mainly performed for in the investigation of acute abdominal pain of uncertain aetiology, allowing therapeutic interventions to subsequently take place as appropriate. Other indications include evaluation of suspected intra-abdominal injuries in haemodynamically stable trauma patients or in the staging of intra-abdominal cancers (including obtaining tissue for histological diagnosis e.g. peritoneal fluid for cytology or peritoneal biopsy).

Laparoscopy is associated with shorter post-operative recovery, lower pain scores, and reduced rate of wound infections compared to open exploratory surgery.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage In laparoscopic surgery, port insertion can damage any intra-abdominal organ, including the abdominal aorta.

It is important to be aware of the inferior epigastric artery when inserting ports into the left or right iliac fossa.

Injury to surrounding structures including bowel, bladder, ureter, liver, and spleen A laparoscopy involves assessing all organs, which can be damaged in the process Decompress the bladder with a catheter
Conversion to open surgery including full laparotomy* This may be necessary if the procedure is difficult or there is other pathology such as a cancer or tumour that requires open resection
Stoma This is rare, particularly in the young, but it may be required in a few cases depending on pathology hence is essential to consent for
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation

*This is not a true complication, merely a consequence of difficult pathology, but always should be included

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will have local anaesthesia into the wounds and simple analgesia post operatively
Bleeding There is a small chance of bleeding and bruising in the abdomen post-surgery
Infection Superficial wound infection is possible, however collections in the pelvis or paracolic gutters can also occur Peri-operative antibiotics will reduce the risk of wound infections
Scarring Any scar may form a keloid scar, particular in high-risk ethnicities
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer, and prolonged bed rest. The patient will be given anti-embolism stockings and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

Late

Complication Description of Complication Potential Ways to Reduce Risk
Hernia Any incision involving the abdominal wall has the potential to cause a hernia in future, either through a port site or in open surgery. Avoid heavy lifting for 6 weeks post-surgery.

Particular care should be taken with epigastric port insertion as defects can be made in the falciform ligament that can lead to internal hernias in the future.

Adhesions Any abdominal surgery may cause adhesions as a reaction to the procedure, however laparoscopic surgery is lower risk than open surgery
Further surgery Depending on the intra-operative findings the patient may require further procedures for definitive management
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