Dr John C. Strachan

M.B.,ChB (Cape Town) M.MED (UOVS),FCS(SA)

General and Laparoscopic Surgeon

V.A.T NO: 4550255311

PR NO 4208544

INFORMED CONSENT FOR LAPAROSCOPICRESECTION LIVER METASTASES

GENERAL RISKS PERTAINING TO THE OPERATION

  • PainThe healthcare team will give you medicine to control the pain.
  • Bleeding – during or after the operation.
  • Infection of the surgical site might occur. Let the healthteam know if you get a high temperature, notice pus in your wound, or if your wound becomes red or painful.
  • Scarring of the skin
  • Blood clot in your leg This can cause pain, swelling or redness in your leg.
  • Blood clot in your lung –(Pulmonary embolus) if a blood clot moves through your bloodstream to your lungs.
  • Chest infection
  • Difficulty passing urine.
  • Hernia formation may occur caused by the deep muscle layers failing to heal.

SPECIFIC RISKS TO THE OPERATION

  • The Laparoscopic technique may not be successful. The Surgeon may need to change technique to open surgery, particularly if you have had previous surgery to your abdomen.
  • Peri-operative blood loss/haemorrhage
  • Subphrenic abscess or biliary fistula
  • Develop a hernia near one of the cuts used to insert the ports.
  • Damage to bowel, bladder or blood vessels when inserting instruments intoyour abdomen.
  • Difficulty passing urine. You may need a catheter put into your bladder for 1 or 2 days if you are not able to pass urine before being discharged.
  • Injury to structures that are in your abdomen eg colon etc.
  • Surgical emphysema –crackling sensation in your skin caused by trapped carbon dioxide.
  • Paralytic Ileus – Continued bowel paralysis where your bowel stops working for more than a few days, causing you to become bloated and sick. A nasogastric tube may be placed in your nostrils and down into your bowel until your bowel works again.
  • Adhesions –caused by scar tissue

ACKNOWLEDGEMENT AND CONSENT FOR OPERATION

I acknowledge that I have read and understand the risks associated with Laparoscopic resection of liver metastases.

I understand:-

  • My medical condition, the proposed procedure to be undertaken & alternative treatments that may exist pertaining to my condition.
  • I understand I have the right to change my mind at any time following a discussion with Dr Strachan and his staff.
  • I consent to the operation being performed.

Name of patient:……………………………………………………………….

Signature …………………………………………………………………..

Date…………………………………………………………………………