Consent is a concept inherent in any nurse-patient relationship and provides nursing with both theoretical and practical challenges. Within the perioperative area written informed consent is obtained for surgical and anaesthetic interventions. Consent is not formally negotiated for the multitude of interventions undertaken to facilitate the most straightforward of surgical procedures. An explorative, qualitative research project was undertaken to explore the processes used by perioperative nurses for negotiating such consent. Data was collected from perioperative nurses working in an acute teaching hospital using ‘consent episodes’ as units of data focusing on daily tasks of perioperative patient care. Findings indicate there is a dominant discourse of implied consent in which perioperative nursing practice is located.

Background Obtaining primary fascial closure following laparostomy can be difficult; especially with fascial retraction or large pre-existing fascial defects. Various techniques have been described in the literature which attempt to improve reapproximation rates. Most techniques described comprise the use of adjuncts including Bogota Bags, negative pressure dressings, anchor devices and various types of mesh. While most techniques achieve primary closure, less achieve primary fascial closure. Botulinum toxin A (BTA) has proven a beneficial adjunct in repairing large ventral herniae. While there is limited research in the use of BTA in the acute setting of laparostomy closure its benefits in elective repair may prove transferrable with the appropriate protocols. Method This retrospective study reviewed 12 cases where BTA was used as an adjunct to close laparostomy. It compared primary fascial closure rates to historical controls at the same institution. Results Seven males and five females. Median age 63.5 years. Median BMI 32.95. Median days from BTA injection to primary fascial closure 9.5. Median 18 days from primary operation to primary fascial closure. 83% of patients achieved primary fascial closure with the rest achieving partial closure with the residual defect bridged with biological mesh. At the time of review, there was only one resulting ventral hernia in a patient with a BMI of 51.7 at the time of surgery. Conclusion While BTA does not guarantee primary fascial closure in laparostomy this study would indicate it improves primary fascial closure rates and can be added to any other existing method for managing the open abdomen. As BTA can be injected via the open abdomen or with ultrasound guidance it can be performed by any appropriately trained surgeon, anaesthetist or radiologist making its use widely achievable. Retrospectively registered.

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