Litigation patterns in inguinal hernia surgery: a 25 year review

Background: Inguinal herniorraphyis among the most common procedures performed by general surgeons, but risk factors for litigation related to this surgery are poorly defined. Methods: Cases were retrieved by searching the Westlaw database from 1991 through 2016 using the search terms “inguinal hernia” OR “inguinal herniorrhaphy” OR “inguinal hernioplasty” and “medical malpractice.” Data were compiled on the demographics of the patient, operative case details, nature of injury, legal allegations, verdicts, and indemnities. Results: Forty-six cases met inclusion criteria and were selected for review. Verdicts for the defendant predominated (67%). The average plaintiff's monetary award for a plaintiff verdict or settlement was $1.21 million (median $500,000). The most frequent legal argument was improper performance (n = 35, 76%), followed by failure of informed consent (n = 14, 30%). The most common complications were nerve/chronic pain (n = 20, 45%) and testicular damage (n = 10, 23%). No association was discovered between case outcome and patient gender (P = 0.231) or age (P = 0.899). Case outcome was not different between open and laparoscopic repairs (P = 0.722). Patient mortality was not associated with case outcome (P = 0.311). There was no chronological trend in case outcome or award amount. Settlement award amounts were not significantly different than plaintiff awards (P = 0.390). Conclusions: Successful litigation after inguinal hernia surgery was relatively infrequent—only 21.7%—with an additional 10.9% resulting in settlement awards. Case outcome in litigation for hernia surgery was not predicted by patient demographics, type of procedure, or type of complication in this data set.