Comparing Perspectives About the Informed Consent Conversation for Laparoscopic Cholecystectomy

Cholecystectomy is one of the most common operations performed. However, there is no consensus regarding the baseline level of detail to be communicated to patients to constitute truly informed consent. The purpose of this study is to compare attending to resident perspectives of the details deemed essential to the informed consent conversation surrounding laparoscopic cholecystectomy.

Attending surgeons performing laparoscopic cholecystectomies (n = 60) and general surgery residents (n = 105) from three institutions were invited to participate in this study. An electronic survey was distributed to all surgeons assessing the background knowledge, risks, benefits, alternative options, and postoperative expectations that surgeons believe should be routinely communicated to patients undergoing laparoscopic cholecystectomy for gallstone disease.

Response rates were 57.4% and 38.1% for attending surgeons and residents, respectively. There were no differences of opinions regarding discussing the risks of bleeding, infection, bile leak, retained stones, bowel injury, potential need for intraoperative cholangiogram, or conversion to an open operation. Seventy-four percent of attendings reported that the potential need for postoperative endoscopic retrograde cholangiopancreatography should be discussed compared to 37.5% of residents (P = 0.001). All attending surgeons believe biliary tree injury should be communicated as a surgical risk compared to 85% of residents (P = 0.017).

This study identifies gaps in resident understanding of what is essential to communicate to patients prior to cholecystectomy compared to experienced surgeons. These results suggest areas for improvement in resident comprehension of the importance of discussing the risk of bile duct injury and in the role of endoscopic retrograde cholangiopancreatography for patients with benign biliary disease. The findings of this study advocate for structured and deliberate training programs focused on the informed consent process.