Imperial College Healthcare NHS Trust

3. Miss C complains about a hysterectomy surgery that took place at Imperial College Healthcare NHS Trust (the Trust) in November 2022.

4. Miss C says the surgery caused her to suffer two incisional hernias and a diastasis rectus and she has to have abdominal wall reconstruction surgery.

5. Miss C says she can no longer do many activities she used to be able to do and she has experienced emotional distress due to the impact on her body and physical scars.

6. Miss C would like a proper apology and acknowledgement of responsibility from the Trust, and a financial remedy.

7. Miss C attended the gynaecology clinic at the Trust in September 2022 after suffering with painful fibroids (non-cancerous growths that develop in and around the uterus).

8. After discussing with the consultant gynaecologist, Miss C decided to have a subtotal hysterectomy (a surgical procedure that removes the main body of the uterus while leaving the cervix in place).

9. The surgery took place in November 2022. Miss C had a follow up appointment in February 2023 in which the notes state she appeared well post-operatively. The Trust then discharged Miss C with a plan to continue regular smear tests.

10. Over the next few months Miss C noticed a lump next to her incision that was only visible when standing up. The lump grew in size and Miss C approached her GP, who referred her back to the Trust’s gynaecology service.

11. Miss C had an appointment in July 2024 in which a consultant gynaecologist examined her abdomen and said the lump appeared to be a hernia. The gynaecologist referred her for an ultrasound.

12. The ultrasound took place in July 2024 but was unclear. Miss C then had an MRI scan in September 2024 which confirmed two incisional hernias and a diastasis rectus (separation of the abdominal muscles).

17. 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.

18. Miss C says the hysterectomy surgery caused her to suffer two incisional hernias and a diastasis rectus and she needs further abdominal wall reconstruction surgery.

19. The Trust said the risks listed on Miss C’s consent form included ‘damage to the surrounding structures, wound complications, symptomatic abdominal adhesions and abdominal scarring’.

20. The Trust said an incisional hernia is a recognised complication of a hysterectomy procedure. It said although the procedure was complex, there were no complications at the time of the surgery. This meant the surgery went as planned, and nothing unexpected happened.

21. An incisional hernia occurs when a section of abdominal tissue or organs (like the intestines) push through a weakened area of a previous surgical incision.

22. GMC professional standards on decision-making and consent say:

‘You must give patients the information they want or need to make a decision. This will usually include:

a. diagnosis and prognosis b. uncertainties about the diagnosis or prognosis, including options for further investigation.

c. options for treating or managing the condition, including the option to take no action d. the nature of each option, what would be involved, and the desired outcome e. the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action. By ‘harm’ we mean any potential negative outcome, including a side effect or complication.’

23. The records show the Trust completed an electronic consent form with Miss C, which provided all the details of the proposed operation.

24. The risk section of the consent form explains that early risks of the procedure can include discomfort, wound complications, vaginal bleeding, incisional hernia, and several other potential complications.

25. Additionally, the Trust’s response explains it discussed several treatment and surgical options with Miss C to decide the best course of action. This included conservative treatment, medication and uterine fibroid embolization (UFE – a minimally invasive, non-surgical procedure to treat uterine fibroids by blocking their blood supply, causing them to shrink and reduce bleeding). Miss C instead chose to undergo a subtotal hysterectomy.

26. Our gynaecology adviser said the records suggest the Trust thoroughly discussed all the appropriate options with Miss C including the risks associated with these. The consent form shows the Trust documented the risks of the surgery Miss C chose in line with relevant standards, one of which was an incisional hernia.

27. Our adviser added that due to the size of Miss C’s uterus, the surgery required a midline incision (a vertical surgical cut made down the centre of the abdomen). The adviser explained this poses a higher risk of incisional hernias than keyhole surgery, which is generally the preferred option for abdominal gynaecology surgeries.

28. The records of the surgery do not show any evidence that anything went wrong, and there were no unexpected complications documented in the notes.

29. Our adviser added that incisional hernias do not develop immediately, and can occur in the days, weeks or months following the procedure. Therefore, it would not be apparent to the staff carrying out the procedure, so there was no action they could take any earlier.

30. We understand Miss C underwent a significant, life-changing procedure which she hoped would resolve the issues she was experiencing. Miss C has told us psychologically she believed she was starting a new chapter with her health and things would slowly return to normality. We appreciate she is concerned about having to have another surgery for the incisional hernias.

31. The evidence we have seen shows this was a recognised risk of the hysterectomy procedure Miss C agreed to, and the Trust thoroughly communicated this to Miss C beforehand. The fact this complication later arose is not an indication that the Trust did anything wrong.

1. We have carefully considered Miss C’s complaint about the Trust. We acknowledge Miss C has had a challenging time since her hysterectomy procedure and is frustrated and upset that she has to have another surgery.

2. We appreciate this has been difficult for Miss C, and we thank her for giving us the opportunity to look into her complaint. We have reviewed all the available evidence, and we have seen no indications the Trust has done anything wrong.