Open and laparoscopic hernia repairs, including mesh repairs
A significant number of claims related to hernia repair surgery. Claimants suffered complications including chronic pain, damage to testicles leading to atrophy, obstructed or perforated bowel, bladder damage, nerve damage, peritonitis, or necrotising fasciitis. In some cases, further surgery was required, such as bowel resection, ileocolic anastomosis, or ileostomy.
While in some cases the surgery itself was alleged to have been performed in a negligent manner, leading to injury of other structures, in a large number of these claims it was alleged that the pre-operative consent process was inadequate and that claimants were not fully informed of the potential risks and benefits of the procedure. This was particularly seen in cases where chronic pain was alleged to be a consequence of mesh insertion.
In our analysis, it was identified that in a number of settled claims there was failure to warn of possible complications or provide information on the alternatives to the procedure. There was evidence of inadequate consent regarding explaining risks of chronic pain or discomfort, recurrence of the hernia, and mesh complications requiring further surgery, such as separation or removal of the mesh.
Our highest total case payment, where failure to obtain informed consent was considered to be a factor in the need to settle the claim, was in excess of £150,000.
Bariatric surgery
Claims involving bariatric surgery included gastric bypass, gastric banding, and insertion of gastric balloons. Claimants suffered complications, such as tearing of the band at the time of insertion, leading to leaks, injury to the stomach, pancreas or bowel, infection, and erosion of the band into other structures.
The majority of claims alleged that the surgery itself was negligent, although in some cases it was alleged that the choice of surgery was incorrect (for example, recommending gastric banding rather than gastric bypass) and that the consent procedure was inadequate.
Further allegations related to post-operative care and failure to recognise complications early, leading to a delay in returning to theatre and prolonged recovery time.
Other claimants experienced complications relating to their gastric bands not functioning, band erosion, or recurrent infections – particularly at the port sites. Some patients returned within one to two years due to a lack of weight loss or gastrointestinal symptoms, and on occasion further surgery was required to diagnose and correct band slippage, migration, or erosion.
Notably, with respect to bariatric surgery claims, there were a number of allegations of inadequate follow up, leading to symptoms of nausea, vomiting, pain (gastric bands), and permanent neurological impairment as a result of vitamin and mineral abnormalities (gastric bypass). This included failure to review or adjust post-operative zinc supplementation, leading to copper deficiency, and ultimately resulting in subacute combined degeneration of the cord.
During the time period under consideration, our highest total claim payment for bariatric surgery was in excess of £200,000.
Cosmetic Breast Surgery
Claims often came from cosmetic breast surgery related to augmentation and mastopexy. Many patients alleged unsatisfactory results, including asymmetrical breasts, scarring, infection, or dissatisfaction with the position of their nipples. In some case this led to depression, feelings of disfigurement, or back pain.
In many of the claims that were settled, there was evidence of insufficient history-taking, leading to inappropriate decision-making along with inadequate consent, including failure to discuss possible implant rupture and the consequences, and failure to discuss the potential impact on breast-feeding should the patient wish to undertake this at a future time.
An ongoing theme was of a failure to manage expectations with respect to the possible outcomes. In some cases, patients had already undergone a number of procedures, either performed by the same surgeon or by another practitioner, where they were unhappy with the outcome. In these situations, further revision surgery often still left patients unhappy with the appearance of their breasts.
During the time period considered, the highest total case payment relating to cosmetic breast surgery was approaching £100,000.
Laparoscopic cholecystectomy
Claims made in relation to laparoscopic cholecystectomy again frequently contained allegations of negligent technique leading to bile duct or hepatic duct injury.
In some cases, post-operative care was criticised, including delays in diagnosis and management of surgical complications, and sepsis. Some patients required further surgery, including the need for laparotomy.
Alleged lack of informed consent also featured in a number of claims, with claimants stating they had not been made aware of the possible risks of the procedure or how likely these were to occur.
Our highest laparoscopic cholecystectomy total case payment was in excess of £280,000.