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Informed consent in elective and emergency laparoscopic cholecystectomy: is

patients' knowledge a complication?

Article in HPB · September 2018

DOI: 10.1016/j.hpb.2018.06.1477

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City, University of London Oxford university hospital NHS Trust
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 Electronic Posters (EP03A-EP03F) e Biliary
Service for the period 2003 to 2015. 34294 cholecystec-
tomy specimens were analysed and divided into periods 1
(2003e2008) and 2 (2009e2015). Data regarding trends in
body mass index in the SA population were derived from 3
previously published studies. Urbanization ratios were
obtained from Statistics South Africa.
Results: In SA, the number of cholecystectomies increased
by 37% in period 2 and was consistent among 7 of 8
provinces. Cois et. al found a significant year on year in-
crease in BMI which correlates with our year on year in-
crease in cholecystectomy rates. They showed lower
obesity rates in rural communities. The Northern Cape was
the only province with a decrease in cholecystectomy rates
in period 2 ( 28.3% (p = 0.0014)). This province also was
the only one to demonstrate more urban to rural migration,
with all other provinces showing the opposite.
Conclusion: Increases in BMI in the SA population cor-
relates with increases in cholecystectomy rates suggesting
an increase in gallstone disease. Residing in a rural area
appears to be protective from obesity with a likely decrease
in gallstone disease and hence fewer cholecystectomies.
EP03C-052
PRE-OPERATIVE RISK FACTORS FOR
CONVERSION FROM LAPAROSCOPIC
TO OPEN CHOLECYSTECTOMY: A 10-
YEAR RETROSPECTIVE STUDY IN A
TERTIARY HOSPITAL IN METRO
MANILA, PHILIPPINES
J. Lee, C. Alfonso and A. M. Torio
Department of Surgery, The Medical City, Philippines
Introduction: Laparoscopic cholecystectomy is the gold
standard procedure for symptomatic calculous cholecys-
titis. Some of the advantages it offers include less post-
operative pain, shorter length of stay, earlier return to
function, and more aesthetically acceptable scars. Conver-
sion to open cholecystectomy however still happens in 5%
to 25% of patients. It is then potentially beneficial to be able
to predict the probability of conversion to open cholecys-
tectomy. If classification by the risk of conversion is made,
patients can be better allocated in terms of timing of pro-
cedure, venue, and surgeon expertise. This study aims to
identify which factors may be associated with a higher risk
for conversion to open cholecystectomy.
Methods: A retrospective chart review included all lapa-
roscopic cholecystectomy cases in The Medical City in a
10-year period from 2007 to 2016. From this set of sub-
jects, patient, disease, laboratory, and imaging variables
were determined. Univariate analysis Kendall’s Tau test
and Chi square test are used to compare conversion rates
among clinical and ancillary variables. Multivariate anal-
ysis with logistic regression is used to identify significant
independent predictors of conversion.
Results and conclusion: Some clinical and ancillary pa-
rameters may be used as potential predictors for conversion
of laparoscopic to open cholecystectomy. It is recom-
mended to do a prospective randomized trial which may
establish the specific predictors of conversion, and further
develop a score or a predictive formula which can be used
for assignation of cases to the appropriate technique of
therapy.
HPB 2018, 20 (S2), S685eS764
View publication stats
S729
EP03C-053
INFORMED CONSENT IN ELECTIVE
AND EMERGENCY LAPAROSCOPIC
CHOLECYSTECTOMY: IS PATIENTS’
KNOWLEDGE A COMPLICATION?
E. Iaculli1, S. Di Carlo2, A. Burls3 and M. Silva4
1
HPB Surgery, University Hospitals Plymouth, United
Kingdom, 2Aurelia Hospital, Italy, 3Department of Pri-
mary Care Health Sciences University of Oxford, and
4
Oxford University Hospitals NHS Trust, United Kingdom
Laparoscopic cholecystectomy (LC) amongst the most
commonly performed elective procedure. Similarly surgery
for acute cholecystitis is increasingly advocated. Although
publicly considered routine operation, LC is associated
with number of complications and high risk of litigations,
especially in the acute setting.
An appropriate consent process is part of high quality
surgical care and reduces rate of litigations. Nonetheless
informed consent (IC) is often underestimated by surgeons
especially for such “routine” procedures and in the emer-
gency wards.
Aim of this study is to investigate appropriateness of IC and
possible differences between acute and elective scenarios.
164 consecutive patients undergoing either elective (n
108) or urgent LC (n 56) were asked to fill an anonymous
questionnaire survey to analyze qualitative aspects of IC
offered, patients’ personal perceptions of the process and
their level of understanding of LC possible complications
after the IC took place.
Almost all patients (98%) were either very satisfied or
satisfied with the IC process. The level of knowledge of
complications was associated with a higher level of satis-
faction. Emergency patients were more likely to experience
perioperative complications compared to patients under-
going elective surgery (p < 0.05), whereas patients who
had elective surgery were marginally better informed.
Elective LC, reading written booklet, age and higher edu-
cation are positive factors for level of complications
awareness.
We showed an overall good patients’ satisfaction of the
IC in LC for both for emergency and elective procedures,
although this doesn’t reflect the real level of knowledge of
complications especially in the acute setting.
EP03C-054
METHODS AND CRITERIA FOR
DIAGNOSIS OF GALLSTONE DISEASE
AND ITS COMPLICATIONS.
DIFFERENTIAL DIAGNOSIS
D. Stoykov1, P. Marinova1, I. Lalev2 and G. Sarafiloski2
1
Hepato-pancreato-Biliary Surgery, and 2Invasive
Gastroenterology, Medical University of Pleven, Bulgaria
Introduction: Gallbladder inflammation and biliary tract
infection are the most common complications of choleli-
thiasis. The early diagnosis of the disease and its severity
are prerequisite for timely treatment and prevention of
complications.
Aim: Tre purpose of the investigation is to evaluate clinical
and iimaging criteria for diagnosis of acute calculouse
cholecystitis and to improve early diagnosis and treatment.