Skip to main content
Top
Published in: Hernia 2/2010

01-04-2010 | Original Article

Litigation following groin hernia repair in England

Authors: B. Alkhaffaf, B. Decadt

Published in: Hernia | Issue 2/2010

Login to get access

Abstract

Purpose

Since 1995, litigation following surgical procedures has cost the National Health Service (NHS) over 1.3 billion GBP (Great British Pounds)/2.1 billion USD (United States Dollars)/1.4 billion Euros. Despite it being the most commonly undertaken general surgical operation, no study has examined clinical negligence claims in England following groin hernia repairs.

Methods

Data from the NHS Litigation Authority of all claims made from 1995 to 2009 was obtained and interrogated.

Results

In total, 398 claims were made. Of these, 209 cases had been settled, of which 144 (46.6%) were in favour of the claimant to a cost of 7.35 million GBP/12 million USD/7.93 million Euros. Testicular injury and chronic pain featured in 40% of all claims. Visceral injuries and injuries requiring corrective procedures were the only predictors of a successful claim (P = 0.015 and P = 0.002, respectively). Claims associated with visceral and vascular injuries were more likely to occur in laparoscopic than in open repairs. Sexual dysfunction and chronic pain resulted in the highest average payouts of 85,467 GBP/140,565 USD/92,177 Euros and 81,288 GBP/133,693 USD/87,674 Euros, respectively.

Conclusion

Patients should be fully informed of the incidence of testicular injury and chronic pain during the consent process. Approaches minimising visceral and vascular injury particularly in laparoscopic repair should be adopted to reduce litigation and improve patient care.
Literature
1.
go back to reference Gurusamy KS, Samraj K, Mullerat P, Davidson BR (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 4:CD006004 Gurusamy KS, Samraj K, Mullerat P, Davidson BR (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 4:CD006004
2.
go back to reference Zhao G, Gao P, Ma B, Tian J, Yang K (2009) Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg 250(1):35–42CrossRefPubMed Zhao G, Gao P, Ma B, Tian J, Yang K (2009) Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg 250(1):35–42CrossRefPubMed
5.
go back to reference Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM (1997) Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 277(7):553–559CrossRefPubMed Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM (1997) Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 277(7):553–559CrossRefPubMed
6.
go back to reference Tamblyn R, Abrahamowicz M, Dauphinee D, Wenghofer E, Jacques A, Klass D, Smee S, Blackmore D, Winslade N, Girard N, Du Berger R, Bartman I, Buckeridge DL, Hanley JA (2007) Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA 298(9):993–1001CrossRefPubMed Tamblyn R, Abrahamowicz M, Dauphinee D, Wenghofer E, Jacques A, Klass D, Smee S, Blackmore D, Winslade N, Girard N, Du Berger R, Bartman I, Buckeridge DL, Hanley JA (2007) Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA 298(9):993–1001CrossRefPubMed
7.
go back to reference Beckman HB, Markakis KM, Suchman AL, Frankel RM (1994) The doctor–patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med 154(12):1365–1370CrossRefPubMed Beckman HB, Markakis KM, Suchman AL, Frankel RM (1994) The doctor–patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med 154(12):1365–1370CrossRefPubMed
8.
go back to reference Vincent C, Young M, Phillips A (1994) Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 343(8913):1609–1613CrossRefPubMed Vincent C, Young M, Phillips A (1994) Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 343(8913):1609–1613CrossRefPubMed
9.
go back to reference Hoosein MM, Towse H, Conn G, Stoker DL (2008) Consenting practice for open inguinal hernia repairs—are we failing to warn patients of serious complications? Ann R Coll Surg Engl 90(8):643–646CrossRefPubMed Hoosein MM, Towse H, Conn G, Stoker DL (2008) Consenting practice for open inguinal hernia repairs—are we failing to warn patients of serious complications? Ann R Coll Surg Engl 90(8):643–646CrossRefPubMed
10.
go back to reference Shiwani MH, Gosling J (2009) Variations in the quality of consent for open mesh repair of inguinal hernia. Hernia 13(1):73–76CrossRefPubMed Shiwani MH, Gosling J (2009) Variations in the quality of consent for open mesh repair of inguinal hernia. Hernia 13(1):73–76CrossRefPubMed
11.
go back to reference Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10):1372–1376CrossRefPubMed Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10):1372–1376CrossRefPubMed
12.
go back to reference Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7CrossRefPubMed Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7CrossRefPubMed
13.
go back to reference Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244(2):212–219CrossRefPubMed Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244(2):212–219CrossRefPubMed
14.
go back to reference Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87(12):1722–1726CrossRefPubMed Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87(12):1722–1726CrossRefPubMed
15.
go back to reference Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88(8):1122–1126CrossRefPubMed Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88(8):1122–1126CrossRefPubMed
16.
go back to reference Ferzli GS, Edwards ED, Khoury GE (2007) Chronic pain after inguinal herniorrhaphy. J Am Coll Surg 205(2):333–341CrossRefPubMed Ferzli GS, Edwards ED, Khoury GE (2007) Chronic pain after inguinal herniorrhaphy. J Am Coll Surg 205(2):333–341CrossRefPubMed
17.
go back to reference Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137(1):100–104CrossRefPubMed Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137(1):100–104CrossRefPubMed
18.
go back to reference Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224(5):598–602CrossRefPubMed Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224(5):598–602CrossRefPubMed
19.
go back to reference Picchio M, Palimento D, Attanasio U, Matarazzo PF, Bambini C, Caliendo A (2004) Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 139(7):755–758; discussion 759 Picchio M, Palimento D, Attanasio U, Matarazzo PF, Bambini C, Caliendo A (2004) Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 139(7):755–758; discussion 759
20.
go back to reference Smietanski M, Bigda J, Zaborowski K, Worek M, Sledzinski Z (2009) Three-year follow-up of modified Lichtenstein inguinal hernioplasty using lightweight poliglecaprone/polypropylene mesh. Hernia 13(3):239–242CrossRefPubMed Smietanski M, Bigda J, Zaborowski K, Worek M, Sledzinski Z (2009) Three-year follow-up of modified Lichtenstein inguinal hernioplasty using lightweight poliglecaprone/polypropylene mesh. Hernia 13(3):239–242CrossRefPubMed
21.
go back to reference Fong Y, Wantz GE (1992) Prevention of ischemic orchitis during inguinal hernioplasty. Surg Gynecol Obstet 174(5):399–402PubMed Fong Y, Wantz GE (1992) Prevention of ischemic orchitis during inguinal hernioplasty. Surg Gynecol Obstet 174(5):399–402PubMed
22.
go back to reference Matsuda T (2000) Diagnosis and treatment of post-herniorrhaphy vas deferens obstruction. Int J Urol 7 Suppl:S35–S38CrossRefPubMed Matsuda T (2000) Diagnosis and treatment of post-herniorrhaphy vas deferens obstruction. Int J Urol 7 Suppl:S35–S38CrossRefPubMed
23.
go back to reference Reid I, Devlin HB (1994) Testicular atrophy as a consequence of inguinal hernia repair. Br J Surg 81(1):91–93CrossRefPubMed Reid I, Devlin HB (1994) Testicular atrophy as a consequence of inguinal hernia repair. Br J Surg 81(1):91–93CrossRefPubMed
24.
go back to reference Sheynkin YR, Hendin BN, Schlegel PN, Goldstein M (1998) Microsurgical repair of iatrogenic injury to the vas deferens. J Urol 159(1):139–141CrossRefPubMed Sheynkin YR, Hendin BN, Schlegel PN, Goldstein M (1998) Microsurgical repair of iatrogenic injury to the vas deferens. J Urol 159(1):139–141CrossRefPubMed
25.
go back to reference Junge K, Binnebosel M, Rosch R, Ottinger A, Stumpf M, Muhlenbruch G, Schumpelick V, Klinge U (2008) Influence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia 12(6):621–626CrossRefPubMed Junge K, Binnebosel M, Rosch R, Ottinger A, Stumpf M, Muhlenbruch G, Schumpelick V, Klinge U (2008) Influence of mesh materials on the integrity of the vas deferens following Lichtenstein hernioplasty: an experimental model. Hernia 12(6):621–626CrossRefPubMed
26.
go back to reference Ridgway PF, Shah J, Darzi AW (2002) Male genital tract injuries after contemporary inguinal hernia repair. BJU Int 90(3):272–276CrossRefPubMed Ridgway PF, Shah J, Darzi AW (2002) Male genital tract injuries after contemporary inguinal hernia repair. BJU Int 90(3):272–276CrossRefPubMed
27.
go back to reference McLean TR (2006) Risk management observations from litigation involving laparoscopic cholecystectomy. Arch Surg 141(7):643–648; discussion 648 McLean TR (2006) Risk management observations from litigation involving laparoscopic cholecystectomy. Arch Surg 141(7):643–648; discussion 648
28.
go back to reference McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD001785 McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD001785
Metadata
Title
Litigation following groin hernia repair in England
Authors
B. Alkhaffaf
B. Decadt
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
Hernia / Issue 2/2010
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-009-0595-x

Other articles of this Issue 2/2010

Hernia 2/2010 Go to the issue