A pain in the groin

A pain in the groin

Mr G, a sixty-nine-year-old retired teacher, was referred by his GP, Dr A, to general surgeon Mr M. Dr A felt there was a possibility that his patient Mr G had a left inguinal hernia. He could feel swelling around the area but could not elicit a hernia and wanted Mr M’s opinion. Dr A noted in his referral letter that the suspected hernia wasn’t causing Mr G any trouble.

General surgeon Mr M examined Mr G and confirmed there was a left inguinal hernia. He discussed the treatment options and surgery to repair the hernia was agreed. On the morning of the operation, Mr G signed a consent form, but it did not list the risks or intended benefits of the procedure. Later that day, Mr M carried out a mesh repair of the hernia, which went smoothly and Mr G was discharged the following day.

However, several months later, Mr G complained of persistent groin pain to his GP. He was referred to general surgeon Ms K who examined him clinically and by ultrasound, and found no evidence of recurrence of the hernia. However, Ms K did identify one of the metal staples from the hernia repair operation as the cause of Mr G’s pain. Local anaesthetic and steroid was injected into the area under ultrasound guidance to treat the pain, with a view to considering an operation to remove the staple if the pain did not improve.

Three months later, Mr G was seen by a urological surgeon, Mr R, with a history of a disappearing left testicle over the past four to five weeks. A Doppler study was conducted to check the blood flow to the testes, which showed a small left testis but no other abnormality. Testicular atrophy secondary to the hernia repair was diagnosed.

One month later, Mr G had two staples from his previous hernia operation removed. Mr G was examined two weeks later. His pre-procedure pain was greatly improved although he still experienced ‘twinges’ of pain on sitting.

Mr G brought a claim against Mr M, alleging that he had suffered considerable post-operative pain and testicular atrophy. 

Expert opinion was critical of Mr M’s note keeping. There was no documentary evidence in the hospital notes, GP notes, or correspondence that Mr M had effectively explained the complications of inguinal hernia repair to Mr G. As a result, the case was settled for a moderate sum.

Learning points:

  • Post-operative pain is not necessarily negligent as it is a recognised complication of the procedure. Similarly, testicular atrophy is a non-negligent complication of the procedure with a rate of occurrence of about 2%.
  • Expert opinion found Mr M’s consent form to be lacking in detail. Post-operative pain and testicular atrophy should always appear on the consent form as possible complications with this operation.
  • Record details of discussions around consent for the procedure and the appropriate risks and benefits.
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