Consent: Laparoscopic Cholecystectomy

Original Author: Ollie Jones
Last Updated: February 14, 2019
Revisions: 7

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

Removal of the gallbladder, or cholecystectomy, is undertaken due to gallstone disease and is typically performed laparoscopically.

Depending on local centre resources, many patients will undergo on-table cholangiography to assess for biliary stones, or an MRCP pre-operatively may be performed, to see if further intervention for stone retrieval is warranted.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage to any of the surrounding structures through laparoscopy or during dissection off from the liver bed.
Injury to surrounding structures including bowel, bladder and ureter, liver, spleen A laparoscopy should always involve assessing all organs, which can be damaged in the process. Decompress the bladder with a catheter
Bile duct injury Whilst rare (1 in 300-500 risk), they are potentially devastating injuries. The patient can become extremely unwell very quickly.  They usually require major reconstructive surgery and are in hospital for several weeks as a consequence Ensure the “critical view of safety” is always obtained before dividing any structure.
Conversion to open This may be required if the anatomy is unclear, there are stones in the common bile duct, or there is damage to the liver or bile ducts.
Sub-total cholecystectomy* and drain insertion If the anatomy is unclear or there is dense inflammation, it is sometimes safer to perform a sub-total cholecystectomy and leave the drains in.

This results in the patient staying in hospital for a couple of extra days and in some cases requires a post-op ERCP.

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 a safe technique to use in difficult cases and avoids damage to the bile duct

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will most likely have a local anaesthetic at port sites and require simple analgesia only post-operatively.
Bile leak This can be from a bile duct injury (as above), but is usually due to a clip slipping off the cystic duct.  Re-operation is almost always required
Bleeding There is a small chance of bleeding and bruising in the abdomen post-surgery. Ensure sufficient haemostasis achieved prior to closing the abdomen
Infection Superficial wound infection is possible, however collections in the pelvis or paracolic gutters can also occur with intra-abdominal infections. Peri-operative antibiotics will reduce the risk of wound infections
Scarring Any scar, especially if converted to open, may form a keloid scar, particular in high risk ethnicities. Laparoscopic surgery will minimise this risk
Seroma A swelling of lymphatic fluid may occur in redundant subcutaneous space following surgery.
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
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure. Laparoscopic surgery will minimise this risk
Hernia This can occur through the port sites. Avoid heavy lifting for 6 weeks
Bile duct stricture Occurs in 0.1-1% of procedures and cause jaundice, requiring surgical intervention or endoscopic stenting.
Diarrhoea or reflux gastritis These can occur due to the bile no longer being stored and released at the time of a fatty meal, causing resultant steatorrhoea or reflux gastritis.

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