Implications of late complications from adhesions for preoperative informed consent

Abstract

SummaryThe process of informed consent is a critical aspect of the doctor-patient relationship. Doctors have a professional duty to provide patients with sufficient information if a treatment is associated with a significant risk. NHS guidelines advise doctors to mention risks that occur more frequently than 1-2% or risks that are serious even if the likelihood is very small. In the case of abdominal and pelvic surgery, risks can broadly be divided into early and late complications. Early complications, such as bleeding and infection, have a close temporal relationship with the operation. Such complications are routinely mentioned during the consent process. In contrast, postoperative adhesions cause changes in the normal anatomy that can adversely affect function many years and even decades after the original operation, leaving patients at lifelong risk for late complications. These late adhesive complications, namely bowel obstruction, mechanical female infertility and chronic pain, are often neglected during the consent process. However, the risks to patients from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by a number of claims against the NHS based on consent issues regarding late adhesive complications of surgery. Therefore, late complications of surgery from adhesions should be included in the pre-operative consent process. This would decrease litigation costs but more importantly also underpins the doctor-patient relationship.

Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy

“…Furthermore, abdominal surgery is associated with long-term consequences of intra-abdominal adhesions which can lead to complications such as small-bowel obstruction, pain, and female infertility [ 7 ]. Complications from adhesions have been reported to occur in approximately 34.6% of patients who underwent abdominal surgery and as long as 50 years following surgery [ 8 , 9 ]. In women, intra-abdominal adhesions are responsible for 20–40% of female secondary infertility [ 9 ].…”

“…Complications from adhesions have been reported to occur in approximately 34.6% of patients who underwent abdominal surgery and as long as 50 years following surgery [ 8 , 9 ]. In women, intra-abdominal adhesions are responsible for 20–40% of female secondary infertility [ 9 ].…”

Traqueostomia no doente crítico na era do consentimento livre e esclarecido

“…In England, for example, the National Health Service recommends the inclusion of complications with percentages above 1 and 2%, in addition to any serious complications, even if they are rarer. Rajab et al 62 suggest that late complications such as bridles after abdominal-pelvic interventions be cited when ICF is requested for abdominal surgical procedures. Similarly, we understand that tracheal stenosis should be remembered as a late complication when consent is requested.…”

“…No rule is applicable to all individuals. Schwartz believes that the transfer of responsibility may have gone too far 62 . Patients often do not want this freedom.…”

Intraperitoneal adhesions—an ongoing challenge between biomedical engineering and the life sciences

“…Intraperitoneal adhesions are fibrous tissue bands inside the peritoneal cavity as a consequence of inflammation or surgical manipulation. In abdominal and gynecological surgery peritoneal adhesion formation is still a major cause of postoperative complications, such as chronic pain, ischaemia, bowl obstruction, and infertility 1–4. Furthermore, the presence of peritoneal adhesions can lengthen operating time5 and increase the risk of intraoperative complications such as bleeding or injury of abdominal organs 1, 6.…”