Download Informed Consent – Biliary Surgery

Robert C Wright, MD, PS – Puyallup, Washington
Informed Consent – Biliary Surgery
Your symptoms, physical exam, and laboratory studies suggest that you have an obstruction or disease in your bile
ducts requiring surgical correction of the problem. The causes for a problem with the biliary ducts are many,
including previous infections in the biliary system, a history of gallstone disease, a history of pancreatic, or
possible cancer. After careful consideration, biliary surgery is now recommended.
Description of the Procedure
An incision is placed either under the right rib cage or in the midline above the navel. The gallbladder (if
present) is identified, along with its attachment to the bile ducts. The gallbladder is removed if planned. The
common bile duct is identified and opened. If a choledochoduodenostomy is planned, the duodenum is
opened, the opening of the biliary and pancreatic duct into the duodenum is identified, and this opening is
surgically enlarged. The duodenum is closed, and a tube is brought out through the opening in the common
bile duct to the skin. The abdomen is then closed.
Additional Procedures that may be done while in Surgery
It is impossible to accurately predict what we will see or encounter when we do this operation. The
following procedures will be performed only if necessary:
1. Cholangiogram – this is a dye picture of the ducts draining your gallbladder. We usually like to obtain a
cholangiogram to see if there are abnormalities in your bile ducts, or if there are gallstones which have
migrated into the bile ducts.
2. Loop or Roux-en-Y choledocho(cholecyst)jejunostomy – if we are unable to gain access to the main bile
ducts, or if the duodenum itself is obstructed, as may be found with severe inflammation or cancer, an
alternative bypass of the obstruction in the bile ducts will still be necessary. This might be done by bringing up
a loop or limb of bowel and attaching it to the main bile ducts or gall bladder in a standard fashion.
Alternatives for Treatment
1. ERCP sphincterotomy – this is often first attempted, in an effort to open up an obstruction of the main bile
ducts. If ineffective, or if recurring obstruction occurs, or if there are reasons why an ERCP sphincterotomy
cannot be done, surgery is usually offered.
2. Percutaneous transbiliary drainage – this is an alternative for short term relief of obstruction of the biliary
system. It is done by a radiologist, usually with CT guidance.
Benefits of Treatment
Chronic biliary obstruction will lead to life threatening problems, including jaundice leading to irreversible
liver failure, or pancreatitis. Surgery in a timely fashion will permit drainage of the bile and pancreatic
secretions in an unimpeded fashion.
Risks/Complications of Treatment
Treatment risks fall into two categories; those that could happen during any operation under anesthesia, and those
that are specific for biliary surgery. In any medical treatment, it is impossible to predict all the things that could go
wrong. Fortunately, complications are the exception rather than the rule. Every reasonable effort is made to avoid
complications. The most common possible complications are as follows:
Possible complications of major surgery
1. Bleeding – this is a problem that could happen any time the skin is cut. The need for a blood transfusion
is rare.
2. Infection – we take special care to prevent an infection, but it is always a possibility, especially for
emergency surgery.
3. Reactions to medications – this could be many things from a minor rash to possible death
4. Reactions to anesthesia and surgery – this could show up as a heart attack, blood clots, pneumonia, sore
throat, or potential death, in rare cases.
5. Poor wound healing – breakdown of the incision.
(see other side)
Possible complications of biliary surgery
1. Inability to relieve the obstruction – multiple strictures, or advanced disease in the biliary system may
lead to a condition that not even surgery can remedy.
2. Injury to bowel or other abdominal organs – an injury to a portion of the bowel or other organs in
uncommon but possible. Should this occur, we will repair the injury. Re-operation may be required.
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual. You should begin walking on the evening of the surgery.
Your diet may be restricted for a while (2-5 days or more) requiring you to stay on IV fluids during that time. You
should not drive a motor vehicle while on pain medication. You should not lift anything greater than fifteen
pounds for several weeks following the operation. After that time, you will only be restricted from activity that
causes discomfort. You will be on unrestricted activity six weeks following the operation. Most people are able
to return to office work or “light duty” three weeks following the operation.
Consent for Treatment
I understand my condition to be a problem with obstruction or other disease in my bile ducts, and am
aware of its risks if untreated. I have read and understand the above explanation of the operation
required. My surgeon has answered my questions, and I choose to proceed with surgery.
I understand that every operation may yield unexpected finding. I give the surgeon permission to act on his
best judgment in deciding to remove or biopsy tissues that appear to be diseased, understanding that
complications may arise from that action.
I understand that while most people receiving biliary surgery benefit from the operation, I may not. My
condition may not improve, and it may worsen. No absolute guarantee can be made.
HIPAA: Before and after surgery, unless otherwise requested in writing by you, visitors whom you invite
to attend the surgery will be informed of the surgical finding, your surgical status, and anticipated recovery
issues for effectiveness of communications. Because of the anesthetic, you may or may not remember these
important details
PRINT NAME OF PATIENT __________________________________________________________________
SIGNATURE __________________________________________________________ DATE _________________
WITNESS ____________________________________________________________ DATE _________________
SURGEON ____________________________________________________________ DATE _________________
RELATIONSHIP TO PATIENT IF SIGNATURE OF LEGAL GUARDIAN ___________________________________
I waive the right to read this form, and do not want to be educated and informed of treatment risks;
nonetheless I understand the need for this surgery and grant permission to the surgeon to proceed on my
behalf.
SIGNATURE _____________________________________________________ DATE _________________
rev 6-03/kab