Inguinal Hernia Repair – Trends in Litigation

Hoosein and colleagues have correctly identified gaps in the consenting process for inguinal hernia repairs. Analysing data from the NHS Litigation Authority reveals a total of 223 claims following inguinal hernia repair made during the period 2002–2007.¹ At the time of analysis, 159 of these cases were closed, representing 5.4% of the total closed cases relating to general surgery during that time period. Damages were paid in 64 cases (‘paid/closed’ ratio² of 40.3%), summing up to a total of £1,636,510 (range, £600 to £170,000). Interestingly, 13 patients based their claim exclusively on ‘failure to be warned on the potential complications of the procedure’. Six patients had fatal outcome and another 11 patients had to undergo orchidectomy as a result of ischaemic orchitis. Further aetiological analysis is presented in Table 1.

Table 1.

Aetiological analysis of complaints and litigation costs associated with hernia surgery during period 2002–2007 (NHS Litigation Authority)

Causes	Closed	Paid	Paid/closed (%)	Mean comp'n/case (£)
Haemorrhage/haematoma	5	2	40.0	50,396
Visceral injury	21	10	47.6	42,150
Operation failure	19	11	57.9	33,981
Ischaemic orchitis	35	14	40.0	25,633
Infection	17	8	47.1	22,938
Chronic pain	18	2	11.1	13,750
Other (non-specific)	29	10	34.5	13,146
Wrong side operation	2	1	50.0	6,500
Venous thrombo-embolism	3	1	33.3	6,000
Wound complications	10	5	50.0	5,320

Comp'n = Compensation. The ‘paid/closed’ ratio indicates the likelihood of a claim to lead to compensation.²

It is evident that the current consent process can potentially fail to inform patients effectively on the sinister risks associated with hernia surgery, thus leading to postoperative patient dissatisfaction and litigation with significant costs for the NHS. Junior trainees need to be appropriately educated on the above risks. We further support the move towards procedure-specific consent forms for such commonly performed operations.