Consent Form for Laparoscopic Cholecystectomy and Cholangiogram

Gallbladder problems are one of the most common conditions of the digestive system and abdomen that requires surgery.   Gallstones are common a common occurrence, although many people with gallstones may not actually experience any symptoms.

If gallstones are causing pain, or other complications such as an inflamed gallbladder, pancreatitis, jaundice, gallstones in the bile duct etc. then removal of the gallbladder is usually recommended.   Removal of the gallbladder is usually achieved through key-hole or laparoscopic surgery, which is known as a laparoscopic cholecystectomy.

Your surgery has been offered because it has been determined that your symptoms are most likely due to one of the above mentioned conditions and that lifestyle and medical therapy are inadequate to manage your symptoms.

WHAT DOES THE GALLBLADDER DO?

The gallbladder is a small sac-like organ that is on the underside of the liver on the upper right side of the abdomen.  It functions to store bile made in the liver.  Bile aids in digestion by breaking down fats, and in between meals when bile is produced by the liver and not required for digestion, it is stored and concentrated in the gallbladder.  When food is eaten, fat is sensed and the gallbladder is stimulated to squeeze out the stored bile.

When the components of bile are not correctly balanced, the bile can solidify into gallstones.  Therefore, if the gallbladder tries to squeeze out bile and there are stones present, a stone can potentially get block the gallbladder causing pain.

If the gallbladder is removed, bile will still flow to the intestine from the liver to do its job, it just won’t get stored in between meals.

COST OF SURGERY

This surgery can be performed in the public and private settings. In the public setting, waiting list times can range from 3 to 12 months depending on a number of factors.

In private, where patients have private health insurance Dr Wong and Dr Lim, depending on the complexity of surgery surgery may have no out-of-pocket fees (no gap) or you may be charged the equivalent to the healthfund specified “known gap” amount, which is usually $500. This amount represents a significantly discounted amount compared to the recommended Australian Medical Association (AMA) Rates which represents the amount also incurred running a medical practice.  For patients with NIB or related healthfunds, a larger out-of-pocket fee may apply due to this healthfund only paying out at Medicare rates.

If patients choose to self-fund their private surgery, this can be costly due to the hospital expenses. In these circumstances, Dr Wong and Dr Lim charges a fee equivalent to the AHSA Group Healthfunds (such as Doctor’s Healthfund, GMHBA etc.) + Known Gap Amount. 

Out-of-pocket surgical fees are payable prior to surgery to secure a surgical date.

PREPARATION FOR SURGERY

You may be required to attend a pre-admission clinic prior to your admission for surgery.

If you are on any blood thinners such as Warfarin, Rivaroxaban, Apixiban, Dabigitran, Clopidogrel or Dipyridamole, you will be instructed when to stop taking these medications prior to surgery.  On the day of surgery, you must not eat or drink anything for SIX HOURS before surgery.  You may drink WATER ONLY up to TWO HOURS before surgery if your surgery is in the afternoon.

If you are on any medications for diabetes, high blood pressure, asthma or any other medical condition please ensure you notify the anaesthetist and us prior to surgery.

If you smoke, it is advised that you stop smoking and do not smoke for at least 2 weeks before surgery to decrease and minimise risk of anaesthetic and surgical complications.

ANAESTHESIA

The surgery must be performed under a general anaesthetic.  If you have concerns about having a general anaesthetic, you should discuss these concerns with the anaesthetist.  Anaesthesia is general safe and effective.  It is important that you provide details of all of your medications and medical conditions to your anaesthetist and surgeon.

THE SURGERY

You will be admitted to hospital on the same day as your surgery.

Once anaesthetized, the surgery is performed through four small incisions – one by the belly button, and three in the upper abdomen as shown in the illustration.  A camera is used to show the inside of your abdomen and fine instruments are used to remove the gallbladder from the liver and also perform an X-ray dye study of the bile ducts to ensure that there are no stones in or injury to the bile ducts.

The surgery usually takes approximately thirty minutes on average, although not all gallbladder operations are the same complexity.  More complicated gallbladders can sometimes take between half an hour to several hours.

Sometimes gallbladder surgery is unable to be performed through key-hole surgery and conversion to an open operation is required.  Dr Wong has considerable experience with the most difficult of gallbladder operations and conversion to an open procedure is unlikely.  He has performed over 600 gallbladder procedures without causing any major bile duct injury – the most feared complication from gallbladder surgery.

CLICK HERE TO WATCH AN INFORMATIVE ANIMATION VIDEO ON GALLBLADDER SURGERY

RECOVERY FROM SURGERY

Patients who undergo uncomplicated surgery will usually go home on the same day of surgery, once you are awake.  Pain around the wound sites should be expected, and this will decrease over the days after surgery.  You will be seen in one week after the surgery either by your GP or your surgeon for follow-up.

No sutures are required to be removed from the wounds and the dressings will be showerproof.  Dressings can be removed after 5 days, or sooner if they are saturated or not intact.

Do not lift anything heavy requiring straining or perform vigorous exercise for 6 weeks.  No driving for 5 days.

There are no dietary restrictions after surgery, but a diet that is healthy and not high in fat is recommended.

Take Paracetamol regularly every 4 to 6 hours for pain, and any stronger pain killers when required for pain.

DIETARY MODIFICATION

It is usually recommended to follow-up a low-fat diet after someone has had their gallbladder removed. In general, everyone is different and their tolerance to different diets will vary. My recommendation is to eat a healthy balanced diet, which usually would involve avoiding really fatty or oily foods anyways.

You will be expposed to different foods over time, and it is through trial and error that you will learn what you are able to or not tolerate after your gallbladder has been removed.

POTENTIAL RISKS OF SURGERY

General Risks of Surgery

• Bleeding

• Nausea after anaesthesia

• Allergic reaction to anaesthesia, medications

• Blood clots in the legs and lungs

• Pnuemonia, Heart attack, Stroke

• Wound infection

• Poor wound healing and scarring

Specific Risks

• Intra-abdominal collection or infection

• Injury to a major bile duct

• Bile leak

• Injury to other organs

• Retained stones in the bile duct that are unable to be cleared during surgery which may require another procedure known as an ERCP

• Some people continue to have ongoing pains even after the gallbladder is removed

• Altered bowel habit

Blood Transfusions and Blood Products

A   blood transfusion  is not expected to be needed as part of surgery, however in an urgent situation it may be advised. Please state whether you consent to a blood transfusion being given if required.

You are encouraged to consent to blood transfusion unless you have a strong reason not to, and understand the consequences of refusing blood transfusion.

Blood transfusion  is when you’re given blood, or components of blood such as red blood cells, plasma or cells called platelets, from someone else (a donor). It is a very safe procedure that can be lifesaving. It may be required if there is significant bleeding during or following the operation.

Compared to other everyday risks, the likelihood of getting an infection from blood transfusion is very low.

Donors and blood donations are screened for a number of infections which can be transmitted through blood, but it is not practical or even possible to screen donations for all infections, therefore, there will will always be a small risk associated with having blood transfusion.

Reactions can also occur despite best measures having been made to administer blood that is compatible with your blood type. Because of the strict processes and pathways that exist to match blood type, the check-points to eliminate error, serious blood incompatability reactions are very rare. Occasionally, mild reactions can occur such as fever.

Clinical Photography and Video

It is standard practice to capture images whilst performing surgery using the laparoscopic camera system. These photographs document key parts of the surgical procedure and form part of the clinical records for your surgery stored with the hospital and Dr Wong's practice.

Occasionally, de-identified clinical images are required for research study or teaching purposes and if one of the images captured from your surgery depicts a particular teaching point well, it may be used for this with your permission.

Dr Wong or Dr Lim may also record parts of or the entire surgical procedure. This is so that if there are any complications that occur during your surgery, the footage can always be reviewed to try to identify a cause.

Third Parties present in the operating theatre

Industry product support specialists may be present in the operating theatre, to provide support to the surgeon and the theatre team for various pieces of equipment such as the laparoscopic camera, stack and screen, surgical devices and instruments or adjunctive agents used such as staple-line reinforcement, sutures or surgical glue.

Other surgical or medical personel may also be present in theatre to observe the surgeon operating to learn about surgery. Such persons may include other surgeons, doctors, nurses, dietitians, medical or nursing students and paramedics. These persons are there purely to learn and observe, and will not have any role in performing or assisting the surgery.

Patient Declaration

Consenting Doctor - to sign prior to surgery

Dr Jason Wong

General, Upper GI and Bariatric Surgeon

Operating out of North West Private Hospital and Mater Private Hospital

Consenting Doctor - to sign prior to surgery

Dr Aaron Lim

General, Upper GI and Bariatric Surgeon

Operating out of North West Private Hospital and Mater Redland Hospital

Only complete this section if you have been instructed to by Dr Wong

Please sign here if you have been instructed to re-confirm your surgical consent