Consent: Appendicectomy

Original Author: Ollie Jones
Last Updated: February 14, 2019
Revisions: 5

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

Appendicectomy is typically performed laparoscopically, however open appendicectomy remains a common procedure worldwide.

The advantage of the laparoscopic approach is the minimally invasive approach and the ease of visualising the uterus and fallopian tubes in women. Post-operative recovery and pain scores are also reduced with this approach, as is the risk of wound infections.

It is important to run along the bowel for all cases, especially if the appendix appears normal, to look for a Meckel’s diverticulum.

Figure 1 – A laparoscopic appendicectomy

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.  Particularly at risk is the inferior epigastric artery, which one should be aware of during the left iliac fossa port insertion
Injury to surrounding structures including bowel, bladder and ureter, liver, spleen A laparoscopy involves assessing all organs, which can be damaged in the process. The diagnosis of appendicitis is uncertain and therefore pathology in any other area may require resection (e.g. fallopian tubes, small bowel etc.) Decompress the bladder with a catheter
Conversion to open surgery including full laparotomy* This may be necessary if the procedure is difficult, for example if the appendix is extremely inflamed and you cannot safely secure the base laparoscopically, or if there is other pathology such as a cancer or carcinoid tumour.
Removal of ovary / fallopian tubes It is important to emphasise to the patient that this is very rare, but it is occasionally necessary if the pathology causing the symptoms is actually tubo-ovarian in origin.
Stoma This is rare, particularly in the young, but it can be required in a few cases 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 stocking 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 has the potential to cause a hernia in future, either through a port site or in open surgery. Avoid heavy life for 6 weeks post-surgery.
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure.
Reintervention There is always a potential for further surgery due to infections or slippage of ligatures.  This is up to 5% in contemporary Western studies.

 

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