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Testicular atrophy after hernia surgery

1 January 2002

Medical history

The patient, a 40-year-old man, presented with a lump in his right groin. His GP diagnosed a hernia and referred him to a consultant general surgeon who recommended a polypropylene mesh repair. The surgery was routine, using marlex mesh in which a hole approximately 1.5cm in diameter and a lateral slit had been cut and through which the spermatic cord passed. This was recorded in detail in the operation notes. The surgeon examined the patient the following day, detected no abnormality and discharged him from hospital. The patient was advised not to work for at least a week and not to drive until he had been seen in outpatients 10-12 days later. His right testicle was slightly uncomfortable but the patient took this to be a normal consequence of the operation.

On that and the next day he went about his normal activities – working and driving his car. On the third post-operative day the patient experienced pain so acute that he found it difficult to walk. His testicle was swollen and bluish in colour. He consulted his GP who diagnosed an infection and prescribed antibiotics. The following day he was seen by the surgeon who advised the patient to continue taking the antibiotics. The patient's testicle remained swollen and acutely painful for two months, then began to shrink. Five months after the surgery it had reduced to about half the size of the left testicle and was hard, smooth and insensitive.

An ultrasound examination revealed ischaemic damage to the testicle. The patient was advised that the right testicle would continue to shrink until it became virtually non-existent. Six months later the remainder of the testicle was removed and replaced with a prosthesis by a consultant urologist. The patient's fertility was unaffected.

Negligence alleged

It was alleged that the surgeon who carried out the hernia repair performed the surgery in such a manner that the spermatic cord was compressed, obstructing of the flow of blood draining from the right testicle and causing subsequent loss of the testicle.

Expert opinion

An expert witness for the patient said:

'...it appears that the orifice created for the spermatic cord at the abdominal wall was too tight, which led to vascular obstruction and subsequent infarction of the right testis. In failing to ensure an adequate orifice to allow normal blood flow to and from the right testis, the surgeon failed to exercise the required level of skill and competence.'

However, the MDU's expert witness disagreed:

'The operation described by the surgeon in the hospital notes was conducted according to standard practice and there is no evidence that it was performed in any way that could be construed negligent.' He concluded: ...'this kind of problem can occur with any form of hernia repair and around one per cent of patients seem to be affected in this way.'

Outcome of claim

The case went to trial, where the judge discounted the opinion of the patient's expert witness because he specialised in a different area of medicine. He ruled that the surgeon had performed the operation with all due care and competence and that the complication did not arise from any negligence on his part. The patient was ordered to pay the surgeon's costs.

This guidance was correct at publication 01/01/2002. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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