3. Mr B complains the Trust failed to identify and repair a hernia during his surgery on 11 February 2024.
4. He says he had unnecessary surgery which left him with a scar. He also had to pay for private treatment to have the hernia diagnosed, which left him with a financial loss.
5. Mr B is seeking a financial remedy.
6. In September 2023, Mr B had an ultrasound scan which showed a left inguinal hernia His GP referred him to the Trust for surgery. It carried out the surgery in February 2024. Following the surgery, staff told him the surgeon did not find a hernia. An inguinal hernia happens when fatty tissue or part of the bowel pokes through into the groin at the top of the inner thigh. It pushes through a weak spot in the surrounding muscle wall into an area called the inguinal canal.
7. Mr B returned to his GP in March 2024 and requested a second opinion as he was still experiencing pain. The Trust declined his request. Mr B later paid for a private scan which showed a left femoral hernia. He is currently waiting for a further surgery to have this removed. A femoral hernia is similar to an inguinal hernia as they both occur when fatty tissue or a part of your intestine poke through into the groin at the top of the inner thigh. A femoral hernia involves a part of the intestine poking through the femoral canal. The femoral canal is part of your inner thigh which houses a femoral artery.
11. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
12. On 11 February 2024 Mr B had an elective open left inguinal hernia repair (a surgery that pushes the bulge back into place and strengthens the weakness in the abdominal wall). He told us when staff woke him up following the surgery, they told him he did not have a hernia, and the surgeon instead removed some scar tissue from a previous surgery. Mr B believes the surgeon failed to identify the hernia or repair it.
13. We are sorry to hear of the shock and confusion Mr B experienced following this surgery. We appreciate this has left him with ongoing worry Trust staff missed an opportunity to repair his hernia during this procedure. We recognise how important his health is to him, and we hope to reassure him we have taken his complaint seriously.
14. To address Mr B’s concerns, we asked our adviser whether it appears the surgeon failed to identify and repair the inguinal hernia during his surgery. Our adviser reviewed Mr B’s medical records, including the images taken during the surgery and the Trust’s responses.
15. GMC ‘Good Medical Practice’ says doctors must ‘adequately assess a patient’s condition’, ‘provide suitable advice, investigation or treatment’ and ‘propose, provide or prescribe effective treatment based on the available evidence’.
16. Our adviser told us to ‘adequately assess’ if a patient has a hernia, the clinician should physically exam the patient and refer them for an ultrasound. If required, the clinician should then carry out surgery to diagnose the hernia.
17. The records show in September 2023, Mr B had an ultrasound which indicated he had a left inguinal hernia. In line with GMC guidelines, Trust staff correctly decided to arrange surgery for him to ‘adequately assess’ and ‘investigate’ this further to confirm this diagnosis.
18. Mr B’s records show he had surgery on 11 February. The plan was to explore whether he had a hernia and if so, carry out a hernia repair. On the morning of the surgery, Mr B had a CT scan (computerised tomography uses several images and X-rays to create detailed images of bones and soft tissue). The report from this CT scan states, ‘the known left groin hernia is poorly visualised on this examination’. Our adviser also reviewed the images taken during the hernia repair surgery and confirmed there is no indication of an inguinal hernia on these images.
19. We appreciate this is not what Mr B had previously been told. The Journal of Ultrasound in Medicine states ultrasounds are ‘quite sensitive at picking up hernias and are usually around 90% to 100% accurate’. However, importantly ultrasounds can sometimes give false positive results for hernias.
20. The Trust’s response to Mr B explains the surgery was to ‘confirm diagnosis’ of the inguinal hernia. It stated the procedure was to ‘take a look, via keyhole surgery, with the option to repair’ it. Mr B’s hernia had not been formally diagnosed at this point.
21. On balance, it appears Mr B’s first ultrasound scan likely gave a false positive result for an inguinal hernia. The CT results, imaging from the surgery and the surgical notes appear to support this view. On this basis, we have not seen any indications to suggest Trust staff missed an opportunity to diagnose and carry out a hernia repair on 11 February.
22. On 26 March, Mr B had a second ultrasound which he paid for privately. This ultrasound scan showed he had a left femoral hernia. Importantly, this left femoral hernia was not present on the ultrasound scan of 11 February. The surgical notes also suggest this was not detected during B’s first operation.
23. Our adviser explained even if the surgeon had found the femoral hernia on 11 February, they would not have been able to carry out a repair. This is because, this is a different type of hernia and Mr B had not consented to this procedure. GMC guidelines for ‘Decision making and consent’ explain before carrying out treatment, clinicians should discuss the patient’s ‘diagnoses’ with them and the benefits, risk of harm and likely success of each potential treatment option. As this would have been a new diagnosis, it would not have been appropriate to carry out surgery on the femoral hernia, without Mr B’s informed consent.
24. In summary, we do not wish to undermine how distressing this experience has been for Mr B. He has told us of the upset and distress he has faced and the impact this has had on his health. We are sorry to hear of what he has been through. The evidence we have seen indicates the Trust acted in line with GMC guidelines. It took appropriate steps to ‘adequately assess’ whether Mr B needed a hernia repair, by completing ultrasound scans and carrying out explorative surgery to confirm this diagnosis. Having done so, the records indicate it is more likely than not his first CT scan was a false positive. We have not seen any indications to suggest there was a hernia present on 11 February. We hope this reassures Mr B his care has not fallen below the standard expected.
1. We have carefully considered Mr B’s complaint about the care he received from Royal Cornwall Hospitals NHS Foundation Trust (the Trust). We are very sorry to hear Mr B has concerns Trust staff missed an opportunity to repair his hernia on 11 February. He told us this meant he had to undergo a private scan and will need a second hernia repair surgery. We recognise this has caused him significant worry and stress. We are grateful to him for the efforts he has made to bring this complaint to us.
2. We have carefully considered all available evidence and have decided not to take any further action. This is because we have not seen any indications the Trust missed an opportunity to carry out a hernia repair. We have explained the reasons for this below and hope it brings Mr B some understanding around the Trust’s actions.