The High Court has found a colorectal surgeon negligent over anal stenosis and a rectovaginal fistula that developed after an August 2018 haemorrhoidectomy. Mr Justice Michael Hanna ruled that the surgery was not performed to an adequate standard for the patient’s circumstances and assessed general damages at €175,000, with agreed special damages to be added.
The plaintiff, identified in the judgment as A. Z. and anonymised under section 27 of the Civil Law (Miscellaneous Provisions) Act 2008, had Grade IV haemorrhoids, perineal descent and an overactive pelvic floor. After conservative treatment gave only partial relief, she underwent an open haemorrhoidectomy by Professor Robert Hannon at the Beacon Hospital on 13 August 2018.
She later suffered severe pain and difficulty passing stool. Professor Des Winter, who treated her after she lost confidence in the defendant, found significant anal stenosis in April 2019 and dilated the canal. A fistula was discovered in November 2019 and treated with a seton and, in March 2020, a fistulotomy. The judgment says she made a satisfactory physical recovery, but also records an undisputed PTSD diagnosis and continuing need for therapy.
The plaintiff alleged that excessive tissue removal and inadequate skin bridges caused the stenosis, and that a surgical wound caused the fistula. The defendant denied negligence. His case was that skin bridges had been preserved and that the plaintiff’s pre-existing pelvic floor conditions contributed to the stenosis; he also argued that later dilatation or infection could explain the fistula.
The judge found, on the balance of probabilities, that the surgeon failed to leave adequate skin bridges and should have taken a more conservative approach, including leaving larger than average bridges given the plaintiff’s pre-existing conditions. The judgment accepted that the stenosis resulted from the haemorrhoidectomy and found the inadequate bridges probably caused it.
On the fistula, the judge rejected a through-and-through wound but found that excessive tissue removal at the 12 o’clock position probably created a partial-thickness wound. It became infected and developed into a fistula over the following months. The judge considered Crohn’s disease and the later dilatations unlikely causes.
The court found for the plaintiff. It assessed general damages at €100,000 for past injury and €75,000 for future injury, to be supplemented by agreed special damages. The judgment states that the amount of special damages was not before the court when it was delivered; it also allowed for a possible application to reduce the general damages if the agreed special-damage figure already included loss of employment opportunity.