Litigation claims following laparoscopic and open inguinal hernia repairs

R Varley,C Lo,B Alkhaffaf

doi:10.1007/s10029-020-02173-y

Abstract

PurposeGroin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation.MethodsAdministrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared.Results880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair.ConclusionsThe rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater.

Highlights

In 2017/18 the annual ‘cost of harm’ to the National Health Service (NHS) was estimated to be 7-8GBP (8-9EUR/910USD) billion—a figure that has risen yearly along with the frequency of clinical negligence claims [1]
This study aims to identify the differences in litigation between laparoscopic and open Inguinal hernia repair (IHR) in England including associated costs
The NHS Litigation Authority (NHSLA) is responsible for managing clinical negligence claims made against NHS trusts in England

Summary

Introduction

In 2017/18 the annual ‘cost of harm’ to the National Health Service (NHS) was estimated to be 7-8GBP (8-9EUR/910USD) billion—a figure that has risen yearly along with the frequency of clinical negligence claims [1]. Approximately one third of all countries have judicial systems either wholly or partially derived from English common law including the USA, Commonwealth nations and much of Europe [2] and so much overlap exists. Surgical specialties represent 40% of the clinical negligence claim volume, with general surgery accounting for 9% of all claims [1]. Inguinal hernia repair (IHR) accounts for around 10% of the general surgical workload, with over one in four males expected to undergo an IHR during their lifetime [3]. For every 1700 IHR performed, there is approximately one clinical negligence claim and while this rate is low, the volume of surgery results in significant costs for the NHS [4]

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