Death following inadequate hernia repair surgery

Our specialist clinical negligence lawyers based at Thomson Snell & Passmore’s Tunbridge Wells and Dartford (Thames Gateway) offices, has secured £90,000 for the widow of a woman who died following a hernia repair operation undertaken with inappropriate equipment.

The claimant in this sad medical negligence claim was the husband of a 55 year old woman who had a past medical history of a total abdominal hysterectomy and bilateral salpingoophorectomy surgery following ovarian cancer, as well as an incisional hernia repair at the site of the first operation incision three years later.

The fact that she had undergone these previous surgeries placed her at a higher risk for adhesions (internal scar tissue) which can make future surgeries more risky.

Six years after her first hernia repair she developed abdominal swelling and was diagnosed with a recurrence of her incisional hernia.  The deceased was morbidly obese with a BMI of 40 (as opposed to a normal range of 21).  This was noted at the time of her assessment.

Despite her past medical history, the surgeon at the Maidstone & Tunbridge Wells NHS Trust felt that her hernia was reducible with surgery.  The claimant underwent the 2nd hernia repair the following year.  During the surgery it was noted that there was no clear intra-abdominal space due to the deceased’s obesity and adhesions.

The surgeon used an instrument called a trocar which is a metal hollow tube which is placed through the abdomen and then used as a port to place subsequent instruments through and into the abdomen.  Despite knowing the deceased was obese prior to the surgery the surgeon did not order a bariatric trocar used for obese patients.

During laparoscopic surgeries gas is inserted into the abdominal space to enable the organs to separate and to give the surgeon a clearer picture.  Using a short non-bariatric trocar on an obese patient will make it more difficult for the surgeon to insert the instrument into the peritoneum and to stretch away the abdominal wall from the underlying bowel by gas insufflation.   Furthermore, a gas leak would have been expected, preventing adequate gas insufflation pressure and distension of the abdomen, and therefore preventing adequate vision of the intra abdominal organs.

Because of these difficulties the surgeon converted to an open surgery, where the abdomen is opened up.  After the surgery the deceased vomited during the night and had persistent nausea.

Two days after her surgery she was noted to have an increase in her creatinine levels which indicated impending renal failure.  Her abdomen was tense and she had not opened her bowels since her surgery.  This was indicative of underlying significant potentially life-threatening intra-abdominal pathology.

The deceased suffered from two panic attacks and complained of shortness of breath.  Despite this a surgeon was not asked to review her.

In the earlier hours of the next day the deceased vomited faecal matter and her abdomen was distended, signs of an obstruction in the bowel.  Again no doctor was asked to review.

She continued to deteriorate but was not taken to theatre until 9am.  She suffered a cardiac arrest on arrival in the theatre and was resuscitated.  A hole was found in the small bowel opposite the port site, and she underwent a debridement surgery, washout and repair before being taken to ITU.

Unfortunately the deceased continued to deteriorate and the following day it was noted that her bowel had no blood supply.  Life support was withdrawn and she died.

The team acting for the widow of the deceased contended that the hole in the small bowel was made at the time of the trocar insertion and that the use of inadequate equipment had caused this to occur.  As such the surgeon had clearly failed to recognise the need for bariatric surgical techniques.  There had also been delay in referring the deceased back for surgical review when her condition deteriorated.

The team successfully obtained an out-of-court settlement for the widow of £90,000.