903 Operative Records at Emergency Inguinal Hernia Repair: Improvements Might Avoid Future Litigation
M F Mohamud- Surgery
Abstract
Background
Chronic groin pain (CGP) after inguinal hernia repair is a multi-factorial problem of variable incidence. The literature is concentrated on the management of CGP after elective repair where litigation for pain accounts for up to 40% of claims for negligence.
Method
Computerised surgeon-typed operative reports of all emergencies inguinal hernia repairs in a single DGH over two years were scrutinised. Specifically looking for the descriptions of the handling of the spermatic cord and the nerves of the canal.
Results
Forty-three repairs were performed by surgeons in training using an open approach. The majority were primary hernias (37/43; 86%) and the repair was usually augmented with prosthetic mesh (88%). Cord handling was described in 35 patients (81%) but identification of the ilio-inguinal nerve was documented in only three. No report mentioned ‘seeking but not finding’ the nerve(s).
Conclusions
Surgeons in training seem to disregard documenting the status of nerves at urgent/emergency repair. Lawyers can be forgiven for arguing negligence if operative records omit observations on vital structures prone to ‘inadvertent’ damage. This needs to be emphasised to all those concerned with the emergency repair of inguinal hernias.