PC is a 66 year old gentleman who went to ********* hospital in November 2023. He was found to have a widemouth ventral hernia with small bowel and a low-grade partial obstruction at hernia level. General surgery was consulted. The PC has a prosthetic urethral sphincter and a penile implant. This is for chronic urinary incontinence and has had it since 2021. The CT scans done during his work up in the emergency room identified the hardware for said prosthetics and the surgeon and surgical team claim that they were aware of them prior to the procedure.
The next day, PC underwent robotic repair of incarcerated ventral hernia with onlay mesh. During the procedure, the surgeon saw what he thought was an “abdominal wall seroma” with concern for abscess/mass and performed a needle aspiration. The fluid in question was 20 ml of saline that was the fluid in PC’s reservoir for his urethral sphincter. Obviously, the PC had no urinary control during the procedure and they placed a urinary foley cath intraoperatively. The PC awoke in PACU and was very confused as to why he had the foley because he is unable to have one due to his implants. The surgical staff later recognized the potential error and offered a urological consult.
However, the specialist that performed the original implant was in a different city and the PC did not feel comfortable with anyone but him. It was not until approximately 2 months later in January 2024 that the PC was able to get his incontinence resolved. The damaged reservoir itself could not be removed, instead it was clamped and a second reservoir was placed. There was no other damage to any of the prosthetics or the components.
Currently, the PC has no residual complication, however did need the second procedure and was out of work for 2-3 months.
We are seeking a general surgeon who would be well-versed in hernia repair and additionally would be familiar with these kinds of prosthetics. We appreciate your opinions in advance.
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Do you believe there might have been medical error?
The surgeon had no business aspirating anything during a robotic ventral hernia repair. The fact that it was even considered, let alone actually performed, is indicative of an obvious error. In addition, the fact that the preoperative CT scan had no abdominal wall fluid collection, and the fact that he did have an implant, should have made it obvious to the surgeon not to aspirate anything during this case.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Absolutely. The fluid aspirated from the device immediately led to urinary incontinence. The fact that he lost urinary continence during the case and had to insert a Foley intraoperatively is another sign that this was an error and led to the complication.
What makes you a good expert for this case?
I have.been board certified for ten years and in active practice where I perform robotic hernia repairs routinely. I am the Department of Surgery Chair.
How often do you encounter cases similar to this one in your practice?
I perform robotic surgery on a daily basis and I routinely perform hernia repairs.
Do you believe there might have been medical error?
the general surgeon was not used to seeing prosthetic penile implants with reservoir and should have had urology come see the patient intra-operatively
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Lack of understanding of abdominal anatomy and characteristics of penile implants
What makes you a good expert for this case?
I am an acute care surgeon, I perform lots of abdominal wall hernia repairs acutely
How often do you encounter cases similar to this one in your practice?
Once per year, this is not very common
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