Chronic Pain as a Complication in Open Inguinal Hernia Repair: A Retrospective Study of Consenting Practice in a Single Centre

Spencer Probert; Wenyi Cai; Muhammad Rafaih Iqbal; Omotara Kafayat Lesi; Samer-Ul Haque; Bryony Lovett; Sarah-Jane Walton

doi:10.7759/cureus.23957

Chronic Pain as a Complication in Open Inguinal Hernia Repair: A Retrospective Study of Consenting Practice in a Single Centre

Cureus. 2022 Apr 8;14(4):e23957. doi: 10.7759/cureus.23957. eCollection 2022 Apr.

Authors

Spencer Probert¹, Wenyi Cai¹, Muhammad Rafaih Iqbal¹, Omotara Kafayat Lesi², Samer-Ul Haque³, Bryony Lovett³, Sarah-Jane Walton⁴

Affiliations

¹ General Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR.
² General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Essex, GBR.
³ General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR.
⁴ Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Essex, GBR.

Abstract

Introduction Inguinal hernia repair is one of the most commonly performed procedures in general surgery in the United Kingdom. Chronic pain as a long-term postoperative complication of this procedure has been extensively documented in the literature. However, this complication is often undisclosed during the consenting process. This omission impairs the patients' informed decision-making process. The Montgomery v Lanarkshire Health Board case, in 2015, changed the way in which patient consent is viewed legally. This has made proper consent practices more important to surgeons undertaking procedures. Aim The objective is to assess if there has been an improvement in consenting practices by comparing consent forms from 2015 (the year of the Montgomery ruling) and 2019, specifically in regard to the risk of chronic groin pain following open inguinal hernia repair with mesh. Methods This was a retrospective review of patients who underwent open inguinal hernia repair using a prosthetic mesh in 2015 and 2019. The medical records were retrieved on the trust's electronic medical record system using the patient's hospital number. The following parameters were obtained: patient demographics, preoperative clinic letters, operation notes and consent forms. The clinic letters and consent forms were systematically reviewed for any mention of chronic groin pain. Results In 2015 and 2019, 163 and 56 open inguinal hernia repairs with mesh were performed, respectively. The median age of patients was 63 (28-88) and 64.5 (19-88) in the respective years. Throughout both years there was a predominance in male patients, and the majority of cases were performed on an elective basis. Consent for chronic pain was present in 60.7% and 62.5% of cases in 2015 and 2019, respectively (p=0.055). Conclusion Despite the importance of adequate consenting practice, we found no significant improvement in consenting practice for chronic pain following open inguinal hernia repair in the four years following the Montgomery ruling.

Keywords: chronic pain; complication; consent and capacity in uk law; general surgery; health care law; hernia mesh; inguinal hernia repair; patient consent.