Consent for laparoscopic appendicectomy
PLAB 2 & PRES 3 · surgery · medium · 8 minutes
Candidate brief
You are an FY2 doctor/SHO in the surgical assessment unit. Mr Adam Clarke, 34, has CT-confirmed acute uncomplicated appendicitis. The surgical team has recommended a laparoscopic appendicectomy. Explain the diagnosis and proposed operation, discuss benefits, risks and alternatives, and obtain informed consent if appropriate. You do not need to perform an examination.
What examiners look for
Consent is a conversation, not simply obtaining a signature. Presume that an adult has capacity unless there is a reason to doubt it. Ensure the decision is voluntary and that pain, anxiety or time pressure have not prevented meaningful participation. Explain the diagnosis, purpose of surgery, expected benefits, material risks, reasonable alternatives and what may happen without treatment. Find out what matters to the individual patient. Risks relating to work, recovery, scarring, previous anaesthetic experiences or particular fears may be material even if uncommon. Laparoscopic appendicectomy is performed under general anaesthesia through small abdominal cuts. Conversion to open surgery may be required if keyhole surgery cannot be completed safely. Discuss antibiotics or observation as an option only for selected uncomplicated cases under the specialist and local pathway. Do not imply that conservative treatment is suitable for every patient. Explain that untreated appendicitis can progress to perforation, abscess, peritonitis and sepsis. The clinician taking consent must understand the operation and be able to answer questions. Seek an appropriate senior if working beyond competence. The patient may refuse or withdraw consent at any time. Document the discussion, questions, patient-specific concerns and final decision.
Guideline references
- https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent
- https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent/the-seven-principles-of-decision-making-and-consent
- https://healthservice.hse.ie/staff/procedures-guidelines/hse-consent-policy/
- https://www2.healthservice.hse.ie/organisation/national-pppgs/hse-national-consent-policy/
- https://www2.hse.ie/conditions/appendicitis/treatment/
- https://www2.hse.ie/conditions/appendicitis/complications/
- https://www.nhs.uk/conditions/appendicitis/
- https://www.guysandstthomas.nhs.uk/health-information/appendicectomy
- https://www2.healthservice.hse.ie/organisation/national-pppgs/national-policy-and-procedure-for-safe-surgery/
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