Our client instructed Shoosmiths to investigate whether the LLETZ procedure she underwent was negligent and caused her to become temporarily incontinent.
What is a LLETZ procedure?
LLETZ stands for large loop excision of the transformation zone and refers to treatment to remove abnormal cells in the cervix using a heated loop wire (see www.nhs.uk/conditions/colposcopy/what-happens/ and Tests to diagnose | Cervical cancer | Cancer Research UK).
Prior to the negligence, our client had undergone two LLETZ procedures which were successful.
In 2015, our client had a smear test which revealed abnormal cells. It was confirmed that they were not cancerous. Following another smear test in 2020, our client was told she would need to undergo a procedure under general anaesthetic to allow the surgeon to look deeper into her uterus.
In late 2020 she attended a pre-operative assessment. During the assessment she was informed that she would be having a LLETZ procedure, but she was not given any information as to what this would entail so she queried it with a nurse. Unfortunately, the nurse said she could not expand any further as she was unable to open our client’s file on the hospital system. She was advised to speak to the consultant on the day of the procedure, which was due to take place in January 2021.
On the day of the procedure, our client attended the hospital and asked the registrar about the LLETZ procedure. The registrar assured her that it was nothing to be concerned about and explained that the procedure would allow him to see where the cells were coming from.
Following the procedure, our client was encouraged to eat and drink, and was advised by a nurse to sit up in a chair. As soon as she stood up, she realised that she was leaking urine. She explained her concerns to the nurse, but they were dismissed, and she was offered paracetamol before being discharged. However, she would continue to leak urine when she stood up and required plastic bags and a towel to cover the car seat for her journey home.
She called the hospital 48 hours later for advice, as she was still leaking urine. Our client was asked to return to the hospital for an examination. The Registrar who had performed her operation catheterised her, as he believed the leaking was due to an infection. She was given antibiotics before being discharged home.
However, she continued to leak a considerable amount of urine, meaning she was unable to return to work and required care and assistance from her family members. As her symptoms continued, she attended A&E. The catheter was replaced with a larger catheter but there was no improvement, so a urologist and gynaecologist reviewed her. Our client was informed that she would be booked to undergo a cystogram, as they wanted to confirm the issue. She was given incontinence pads before being discharged, and she was also given a course of antibiotics.
She attended the hospital to have the cystogram and was subsequently advised that they had found a hole (fistula) between the bladder and the vagina. She was told that this should heal on its own and was discharged with a catheter in situ.
Four months after the surgery, another cystogram confirmed that the fistula had closed on its own and the catheter could be removed. Once the fistula had healed, our client was able to return to work on a phased return, on a part time basis.
We commissioned a report from an expert consultant in gynaecological oncology, who confirmed that there was a failure of proper assessment by an experienced colposcopist prior to the surgery. Our expert identified that the procedure was performed by a junior doctor, which was inappropriate due to the complexity of the procedure and our client’s complex medical history. Our expert confirmed that the fistula was a result of negligence, which caused the incontinence.
The defendants admitted there was a failure to perform the LLETZ procedure adequately and accepted that the fistula had been caused by thermal damage during the LLETZ procedure. They also admitted that if the procedure been adequately performed, our client would have avoided the fistula and urinary incontinence.
The experience has been extremely traumatic for our client, and she was unable to return work for five months after the operation. We also instructed a psychiatry expert who confirmed that our client has suffered a psychiatric injury because of the negligence, and that it has had a knock-on effect on her anxiety, especially when in a medical environment. As part of the claim, we were able to claim the cost of private treatment for the psychiatric injury.
The case settled in our client’s favour out of court.
A quote from our client:
“once again, thank you to yourself (Mahira) and Andrea for everything you have done, this has been much appreciated.”
Andrea Rusbridge, partner in Shoosmiths’ serious injury team comments:
"Unfortunately, an injury to the bladder during a LLETZ procedure can happen and is not necessarily the result of negligence. However, in this case, there was negligence due to the failure to recognise the complexity of the surgery and ensure that a surgeon with the correct level of experience carried out the procedure. This case was important to our client because the injury had a profound effect on her self-worth, independence, and ability to work."
This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024