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Your guide to gynaecological surgery

Pregnant woman speaking to a doctor - gynaecological surgery

Complications during gynaecologic surgery are sometimes due to the uterus (womb) and ovaries being very close to other organs, such as the bowel, urinary tract, nerves, and blood vessels.

Many of the operations are routine and nearly always carried out safely by an experienced and competent surgeon involving either:

  • Laparoscopic surgery - known as “keyhole” surgery
  • “Open stomach” surgery
  • Intravaginal surgery – within the vagina
  • Surgery to the vulva – external female genitals 

As with all operations, each type of surgery carries its own specific techniques and risks.

The role of today’s surgeon is no longer simply to select and perform an appropriate procedure. There is an increasing emphasis placed on creating individual “risk reduction” strategies and patient counselling, which are aimed at lessening the chance of something going wrong at any stage.

A surgeon owes you a duty of care to:

  • Carefully explain any risks that may occur during or after your procedure.
  • Thoroughly check your medical history and test for any conditions or circumstances that may present a risk or lead to complications.

The physical harm and psychological injury caused by error, negligence or a sub-standard technique during gynaecological surgery can be truly life-changing. In some cases, the outcome of a negligent procedure will leave a young woman unable to have children.

If you feel strongly that the standard of care you received before, during or after gynaecological surgery fell below the appropriate standards reasonably expected, you may have a claim for clinical negligence.

Reaching a decision to pursue a claim is not always easy, especially for  intimate injuries. Our team of both male and female lawyers are sensitive to the very personal nature of gynaecological claims and how you are likely to be affected.

Your Legal Friend has many years of experience in successfully resolving  different types of clinical negligence cases.  Our specialist knowledge of both legal and medical issues can provide you with all the expert guidance you will need to help you succeed in making your case heard.

We can help you:

  • Find out the reason why something went wrong with your procedure
  • Secure financial compensation for the injury and harm caused.

Recent stats

  • 6% of clinical negligence claims in 2013/14 were for gynaecological procedures.          (NHS Report, July 2014)
  • One in three of 40,000 incontinence and prolapse surgeries performed each year in the UK will need further surgery due to complications.          (NHS England, 2013)
  • Between 1% and  3% of the 13,000 vaginal tape implants used every year in the UK to treat women with stress urinary incontinence cause adverse effects.
  • Around 15% of the 1,500 synthetic mesh implants carried out each year in the UK for women with pelvic organ prolapse cause adverse effects.          (Department of Health, 2012)

Common gynaecological procedures and their risks

  • Removal of an ovarian cyst

Ovarian cysts are fluid-filled sacs that can grow inside or on the surface of the ovaries.  They are usually removed by keyhole surgery, although standard surgery will be required if the ovaries are cancerous.

Risks of ovarian surgery include:

  • Bowel or bladder may be damaged during surgery
  • Ovarian cysts may return
  • Pain may not be controlled
  • Scar tissue may form on the ovaries, fallopian tubes or in the pelvis
  • Infection may develop. 
  • Pelvic organ prolapse (POP)

The pelvic organs - bladder, rectum and vaginal areas – can become stretched out of position during pregnancy.  Known as a prolapse, this may become permanent.

There are two types of procedures:

  • Obliterative surgery - narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure.
  • Reconstructive surgery - reconstructs the pelvic floor with the goal of restoring the organs to their original position. The patient’s own tissues or a synthetic mesh may be used. A procedure to prevent urinary incontinence may be carried out at the same time.

Risks:

A vaginally placed mesh has a significant risk of complications, including mesh erosion, pain, infection and urinary incontinence.

  • Age - surgery at a young age increases the chance that prolapse will recur and may possibly require additional treatment. Surgery at an older age may be affected by general health issues and any prior procedures.
  • Childbearing  or family planning – surgery should be postponed to avoid the risk of a prolapse happening again after corrective surgery.
  • Stress urinary incontinence surgery

Stress incontinence is usually caused by the weakening or damaging of the muscles used to prevent the unintentional passing of urine, often following childbirth.

To reduce pressure on the bladder, surgical treatments include the attachment of a tape or a sling.

Tape procedure risks

  • The need to pass urine increases and becomes more urgent but the patient is unable to completely empty their bladder.
  • Tape can wear away or move over time, requiring surgery at a later stage to adjust this.

Sling procedure

A sling can be made of:

  • Synthetic material
  • Tissue taken from another part of the body
  • Tissue donated from another person
  • Tissue taken from an animal such as cow or pig tissue

Common risks:

  • Difficulty emptying the bladder fully when passing urine.
  • Development of urge incontinence - urine leaks when there is a sudden, intense urge to pass urine, or soon afterwards.

 Hysterectomy

 A hysterectomy is irreversible and a woman should only consent to the operation if she does not wish to have children in the future.  There are two types of hysterectomy:

 Vaginal hysterectomy - the womb is removed through the vagina.

  • Abdominal hysterectomy – the womb is removed through an incision in the stomach. The fallopian tubes and ovaries may also be removed.

A hysterectomy is nearly always necessary if there is a confirmed diagnosis of:

  • Cancer of the cervix (neck of the womb) or uterus (womb)
  • Fibroids - fibrous tissue that can develop in the wall of the womb causing painful and excessive bleeding
  • Endometriosis - where pieces of womb lining appear outside the womb cavity, causing inflammation and discomfort
  • Pelvic inflammatory disease
  • Prolapse of the womb.

The procedure is also usually recommended when ovarian cancer is diagnosed.

Many hysterectomies are still performed even if cancer is not present. A doctor may strongly advise the procedure where bleeding or pain from the womb is causing increasing difficulties.

Risks associated with both procedures:

  • Heavy bleeding during surgery
  • Post-surgery infection involving the wound or bladder
  • Damage to the bladder or tubes that carry urine from the kidneys to the bladder.
  • Dilatation and curettage

A procedure often carried out to stop heavy vaginal bleeding caused by suspected polyps (growths) or cancer of the womb. The cervix (neck of the womb) is opened and a spoon-shaped instrument called a “curette” is used to scrape the lining from the deeper layers of the uterus, which usually stops the bleeding.

Side effects include:

  • Overly-heavy scraping completely removes the womb lining, preventing a fertilised egg from attaching itself.
  • Accidental sterilisation caused by infection of the uterus and tubes. 
  • Anterior or posterior repair (to front or rear of vagina)

Surgery used when birth trauma causes damage to the walls of the vagina.

Risks include:

  • Infection, particularly with a posterior (rear) repair that enters the rectum.
  • Damage to the tube carrying urine to the bladder or to the bladder itself in an anterior (front) repair.
  • Endometrial ablation

This is a common procedure to stop excessive menstrual bleeding. Treatment involves the destruction of the womb's inner lining by scarring the tissue in one of the following ways:

  • Electrical heat - a small electric current heats up a wire loop or ball-shaped sensor
  • Laser ablation - a high-energy beam of light
  • Heated fluid – a deflated balloon is filled with a heated fluid
  • Microwaves (MEA) - a microwave probe that moves from side to side
  • Radio waves – a probe emits radio waves.

Side-effects

  • Nausea
  • Cramping pains or discomfort.
  • Vaginal bleeding during and after surgery, which may last for up to three to four weeks.

Complications

  • Inflammation of the womb lining
  • Infection of the urinary tract (bladder)
  • Damage to the womb, bladder or bowel
  • Burns to the womb, vagina or skin when heated liquids and probes are used

  

  • Ovarian surgery

Removal of an ovary can take place when cancer is confirmed or if there are multiple painful cysts. The procedure may also be carried out if endometriosis (womb lining material) is detected.

It may be considered unnecessary to remove the entire ovary if:

  • There is just a spot of endometriosis on the ovary, or
  • Only cysts are present as they can be drained, leaving behind healthy ovaries.
  • Tubal ligation

Tubal ligation is a form of permanent sterilisation. It is therefore essential that, before a patient consents to proceed with sterilisation, they do so having been made fully aware and also clearly understand that the procedure is permanent. At the same time, a patient should also be informed that there is a slight chance that the procedure will not work and a pregnancy can still occur.

The operation is usually carried out by keyhole surgery.  A portion of the fallopian tube is usually removed to prove that the procedure was successful and the cut ends are tied, burned or clipped.

Risks include:

  • Injury to the abdominal wall or to structures near the fallopian tubes.

 

  • Errors in fitting a contraceptive device

Errors made during the insertion of a contraceptive coil can cause a tear to the uterus.

 

  • Hysteroscopy or Laparoscopy errors

Hysteroscopy (an internal examination of the womb) and Laparoscopy (keyhole surgery) are common minor procedures that should present no difficulty. Poor or negligent technique can cause tears or rips to organ tissue, bleeding and further complications.

Gynaecological surgery claim 

Gynaecological claims can fall into one of two categories:

  • Failure to treat or diagnose a gynaecological complication

          - a failure to carry out appropriate tests, or

          -  misreading test results after having carried out the correct tests

  • Positive action by a doctor that causes a gynaecological injury

          - carrying out an incorrect procedure in response to a certain set of circumstances, or

- carrying out the procedure in an incorrect manner after selecting the correct procedure in a certain set of circumstances.

To bring a successful negligence claim, it will be necessary to prove that:

  • The treatment received fell below an acceptable standard
  • The injury or harm suffered arose as a result of the substandard treatment.

How Your Legal Friend can help you

Mistakes made during gynaecological surgery can lead to painful complications, long term injuries and irreversible damage.

As experienced clinical negligence specialists, we know that the physical and psychological trauma that can arise from a gynaecological injury can also affect personal and social wellbeing.  We also know that you will want to find out why your surgeon failed you or a family member in their duty to provide the expected standard of care and treatment.

From our first conversation and throughout the case, Your Legal Friend is committed to fighting for your interests every step of the way.  Our task is to ensure your voice is heard and your case made in order to bring the hospital, health trust or medical practitioner to account for the harm and suffering caused.

Your Legal Friend is committed to ensuring victims of clinical negligence obtain answers and receive appropriate compensation so that their future medical treatment and care needs are properly met.