Medical negligence in coloproctology.

There has been a significant increase of litigation in the UK in recent years and for this reason it is appropriate to analyse the reasons for civil litigation. Alleged medical negligence in the colorectal field comes from the activity of general surgeons and gynaecologists as well as colorectal surgeons. This communication deals with problems in the coloproctology area irrespective of the surgeon involved. Two hundred and forty-five cases are reviewed, consisting of 49 anal problems, 160 abdominal problems with 24 laparoscopic and 12 colonoscopic injuries. Thirty-two of 49 anal cases had incontinence and these were often difficult to defend, especially the 20 cases due to childbirth injury because of poor documentation. The abdominal problems were due to delay or complications of surgery. The cases based on delay in diagnosis of cancer were often unsuccessful, but the cases of delay in diagnosis of intra-abdominal infection were difficult to defend. Problems occurring in the operative or early post-operative period produced allegations which were often justified, but the late complications of surgery were rarely due to poor standard of care. The laparoscopic injuries included bowel perforation, bleeding and major vascular damage which were not recognized at the time. The colonoscopic cases were chiefly due to perforation, which is easily defended provided the endoscopist is experienced and the risk is recorded in the consent. The cases have yielded a number of lessons which are discussed and compared with the American experience. It is concluded that litigation is traumatic to both plaintiff and surgeon and that better ways should be found to resolve complaints of inadequate care.