Alternative treatment options
According to New Zealand Cholecystectomy -Laparoscopic Surgeons and supported by the Heath and Disability Commissioner (gate keeper for patients to sue surgeons for criminal fraud)
And in terms of NZ Medical council terms of reference for malpractice : involves immoral, illegal or unethical conduct or neglect of professional duty (improper professional conduct)
New Zealand Surgeons do not breach common law and the legally enforceable Code of Health and Disability Services Consumers’ Rights Act (the Code) by advising patients when obtaining informed consent for Cholecystectomy for the treatment of gallstones
Surgeon “advised (the HDC) that he recommended Ms A ( fit and well young 31 year old ) have a (laparoscopic) cholecystectomy “as the only proven and gold standard treatment of symptomatic gallstone disease”. He stated that other possible treatment options were not discussed as no other treatment is recommended in fit patients with symptomatic gallstones
Outcome – Patient died of complications : Source http://www.hdc.org.nz/decisions/search-decisions/2014/11hdc00531/
legally enforceable Code of Health and Disability Services Consumers’ Rights Act (the Code
Patient have the right to the information that a reasonable consumer in his circumstances would expect to receive, including an explanation of the treatment options available and an assessment of the expected risks, side effects, benefits and costs of each option. . Failing to disclose risks during the informed consent process breached Right 6(1)(b) of the Code of Health and Disability Services Consumers’ Rights (the Code).
Without this information, patient was denied that opportunity to give informed consent, Right 7(1) of the code, Right to make an informed choice and give informed consent. Services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of this Code provides otherwise
Submission 1
Queensland Government health Services: informed consent document
“Alternative treatments: Oral Dissolution Therapy. Oral dissolution therapy is the taking of chemicals by mouth to dissolve the gallstones. It is most effective for patients who are not overweight, in a younger age group, have small or single gall stones and a gall bladder that is working well.
Cholecystectomy Laparoscopic consent form: https://www.health.qld.gov.au/__data/assets/pdf_file/0014/152204/hepatobiliary_01.pdf
Submission 2
More about non surgical Treatment option – Dissolution of Gallstones: ursodeoxycholic acid, Actigal®, is a medicine that can be given as a pill to dissolve gallstones. Therapy requires at least 6 to 12 months and is successful in dissolving stones in 40-80% of cases. When surgery is too risky, the symptoms are mild, the stones are small, and rich in cholesterol, dissolution of gallstones is a reasonable alternative.
American College of Gastroenterology – Gallstones in Women
Submission 4:
More about non surgical treatment options: Cholesterol gallstone disease is a common clinical condition influenced by genetic factors, increasing age, female gender, and metabolic factors. Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones, new perspectives regarding medical therapy of cholelithiasis are currently under discussion, also taking into account the pathogenesis of gallstones, the natural history of the disease and the analysis of the overall costs of therapy. A careful selection of patients may lead to successful non-surgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones. The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations, suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe), or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis, might be proposed as additional approaches for treating cholesterol gallstones. In this review we discuss old, recent and future perspectives on medical treatment of cholesterol cholelithiasis.
Therapy of gallstone disease: What it was, what it is, what it will be. Portincasa P1, Ciaula AD, Bonfrate L, Wang DQ. https://www.ncbi.nlm.nih.gov/pubmed/22577615?dopt=Abstract
Submission 5
More about Ursodeoxycholic acid, 250 to 300, 500 to 600, or 900 to 1000 mg/d, was given orally for 6 to 38 months to 53 patients with cholesterol gallstones and functioning gallbladders. Forty-two patients (79%) had greater than 50% reduction in gallstone volume, number, or both, without apparent dose dependence and 27 (50%) of these patients had complete gallstone dissolution. Results of laboratory studies including liver function tests were not affected adversely and biliary lithocholic acid concentration did not increase during therapy. Most biliary symptoms seemed to disappear within 3 months and no patient developed diarrhea.
Thus, ursodeoxycholic acid appears to be a safe and effective alternative to surgery in selected patients with gallstones.
Tint GS, Salen G, Colalillo A, Graber D, Verga D, Speck J, Shefer S. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. https://www.ncbi.nlm.nih.gov/pubmed/7051912
Submission 6
More about Percutaneous cholecystostomy: (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. (first performed by American surgeon, Dr. John Stough Bobbs, in 1867)
Akhan O1, Akinci D, Ozmen MN. Percutaneous cholecystostomy. https://www.ncbi.nlm.nih.gov/pubmed/12204405
Contact dissolution of cholesterol gallstones with organic solvents is emerging as a rapid, safe, alternative treatment for symptomatic cholesterol gallbladder stones. Placement of a percutaneous transhepatic catheter into the gallbladder is a rapid and safe technique. The availability of safe, effective cholesterol solvents and solvent transfer devices means that cholesterol gallbladder stones can be eliminated rapidly and safely by CDOS, without the risk of general anesthesia or surgical dissection of the gallbladder bed. Patients with single gallstones are better candidates for CDOS than are patients with multiple gallstones because recurrence after dissolution is less common. Contact dissolution may well be judged the treatment of choice by the medical-surgical gallstone management team in some patients.
Hofmann AF1, Schteingart CD, vanSonnenberg E, Esch O, Zakko SF. Contact dissolution of cholesterol gallstones with organic solvents. https://www.ncbi.nlm.nih.gov/pubmed/2022421
Submission 7
More about Extracorporeal shock-wave lithotripsy: Extracorporeal shock-wave lithotripsy (ESWL) is an infrequently used method for treating gallstones, particularly those lodged in bile ducts. ESWL generators produce shock waves outside of the body that are then focused on the gallstone. The shock waves shatter the gallstone, and the resulting pieces of the gallstone either drain into the intestine on their own or are extracted endoscopically. Shock waves also can be used to break up gallstones via special catheters passed through an endoscope at the time of ERCP.
Jay W. Marks, MD. Gallstones. https://www.medicinenet.com/gallstones/article.htm
Submission 8
More about bile acid dissolution therapy: Medical therapy with oral bile acids is appropriate for patients who present with small cholesterol stones and for patients with larger cholesterol gallstones who cannot or will not have surgery. Oral bile acids may also be valuable in the treatment of gallstone recurrence before it has become symptomatic or to prevent recurrence after prior succes Am J Surg. 1989 Sep;158(3):198-204.
Hofmann AF. Medical dissolution of gallstones by oral bile acid therapy. The American Journal of Surgery. https://doi.org/10.1016/0002-9610(89)90252-3
