Download Meridian Surgical Services, Inc

Robert C Wright, MD, PS – Puyallup, Washington
Informed Consent – Open Cholecystectomy
Your symptoms and physical exam suggest that you have a problem with your gallbladder requiring its
removal. The causes for a problem with the gallbladder are many, including the development of gallstones in
the gallbladder or in the ducts draining the gallbladder. After careful consideration, an open cholecystectomy
has been recommended.
Description of the Procedure
An incision is placed either under the right rib cage or above the navel. The gallbladder is identified, along
with its attachment to the bile ducts. The gallbladder is removed from its base on the liver and the abdomen
is closed.
Additional Procedures that may be done while in Surgery
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
lodged in the bile ducts that are not otherwise detectable.
2. Common duct exploration – if there is a strong suggestion of gallstones in your bile ducts, it would
be best to surgically remove the stones at the time of your cholecystectomy. This often entails
opening up the abdomen, cleaning out the stones, and then leaving a small “T-tube” in the duct,
which would come out through your skin in the right abdomen. This tube usually remains in for
about three weeks and is easily removed in the office.
Alternative Treatments
1. Laparoscopic cholecystectomy – this is an effective method of treatment for uncomplicated
gallstones. This approach is not offered to everyone, since complicating circumstances may create
an unacceptably high risk from this type of surgery.
2. Non-surgical treatment – there are several other treatments available. One treatment is the use of
pills that dissolve gallstones. We do not recommend this treatment because most people are not
helped or made worse with this medicine. Gallstones will usually come back after the medicine is
stopped. It is also possible to shatter the gallstones using a special machine; this treatment is not
readily available, and has been abandoned in most centers because of its expense and because the
gallstones often recur after this treatment.
Benefits of Treatment/Treatment Objective
There are many benefits to having an open cholecystectomy. If you are having abdominal pain that is caused
by the gallbladder, this operation will usually relieve that pain. A cholecystectomy will also help avoid the
many potential complications form having gallstones, including cholecystitis (an infection of the
gallbladder), ascending cholangitis (an infection of the bile ducts), or pancreatitis. On occasion, these
problems can be so severe as to lead to death.
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 an open cholecystectomy. 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 following any operation
1. Bleeding – this is a problem that could happen any time the skin is cut. The need for a blood
transfusion during or after this operation is uncommon
(see other side)
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.
Possible complications of an open cholecystectomy.
1. Injury to the bile duct – because the operation occurs close to bile ducts, an injury to them (while
uncommon) is possible. Such an injury may not be detected while in the operating room, and
necessitate further operations to be corrected. Also, occasionally stones may be undetected in the bile
ducts and later cause problems. A bile leak will make you feel worse and worse daily after surgery.
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.
3. Lack of improvement: 90% of patients with gallstones, 85% without gallstones resolve upper
abdominal pains. Bowel irregularity commonly persists.
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual. You should begin walking on the evening of the
surgery. 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” two weeks following the operation.
Consent for Treatment
I understand my need for a cholecystectomy. I have read and understand the above explanation of the
procedure being proposed. 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 an open cholecystectomy 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 who 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 _________________
06/03/ljb