A pain in the groin

Mr A, 45 years old, had been suffering from bilateral inguinal hernias. He had a significant history of discomfort in his right groin, radiating down his right thigh and lower back, and was referred to surgeon Mr M.

The fixation was in accordance with accepted good practice and the procedure was uneventful

On examination, Mr M found bilateral inguinal hernias. Mr M discussed the options available to Mr A and advised that surgery would provide a 50/50 chance of helping with the chronic pain. Mr A decided to undergo a laparoscopic excision and repair of the bilateral inguinal hernia, and hoped that the pain would also be improved.

Mr M adopted the standard practice of using mesh for laparoscopic repair that was fixed in place by metal tacks. The fixation was in accordance with accepted practice and the procedure was uneventful.

Postoperatively, Mr A continued to experience pain. He sought a second opinion from Miss D, who considered the pain to be due to nerve entrapment. Mr A underwent an ileo-inguinal and genito-femoral nerve block, and his symptoms did improve.

Mr A was unhappy with the treatment he received from Mr M, as he was still suffering from groin pain, and made a claim.

Expert opinion found that it was entirely reasonable for Mr M to adopt the technique that he used and there was no breach of duty on his part. The expert also found that pain following inguinal hernia repair is not uncommon; the commonest underlying cause being neuropathic pain. The fact that Mr A had clearly explained, and documented that the pain the patient had been suffering prior to the operation may not improve, was significant.

The fact that Mr A had clearly explained, and documented that the pain the patient had been suffering prior to the operation may not improve, was significant

A detailed letter of response, stating that there cannot be a claim that the patient was not informed that the pain would not improve or that the treatment was negligent, was sent and as a result the case was discontinued.

Learning points

  • Postoperative pain is not necessarily an indication of negligence. 
  • In this case, Mr A had a significant history of discomfort in his lower groin prior to surgery and was specifically told prior to surgery that there was only a 50/50 chance of alleviating his pain. 
  • It is important during the consent process to deal with patient expectation and document carefully the discussion that you have had. 
  • It is also important when repairing hernias to warn patients of post-operative discomfort which may become permanent. This should be documented.
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