Hysterectomy — surgical removal of the uterus — is one of the most commonly performed gynaecological operations. For many women it is the right treatment. But it is major surgery, and when performed negligently — damaging the bladder, ureter, or bowel; when a less invasive alternative was not discussed; or when post-operative complications are not managed — the consequences can be permanent. This guide covers when hysterectomy management amounts to clinical negligence.
Common types of hysterectomy negligence
Ureter injury
The ureters run close to the uterine blood supply. Ureteric injury — inadvertent division, ligation, or crushing — during hysterectomy is a known but avoidable complication. Where it occurs due to surgical technique below the required standard, or is not identified at the time (requiring emergency re-operation), a claim may succeed.
Bladder injury
The bladder is closely adherent to the anterior uterus, particularly in cases with previous caesarean sections creating adhesions. Bladder injury requires immediate identification and repair. Unrecognised bladder injury causing urinary fistula is a serious complication.
Bowel injury
Bowel injury — particularly in laparoscopic hysterectomy — requires identification at the time of surgery and prompt repair. Unrecognised bowel perforation causing peritonitis is life-threatening.
Failure to offer alternatives to hysterectomy
For women with heavy menstrual bleeding or fibroids, alternatives to hysterectomy exist: levonorgestrel-releasing IUS (Mirena), endometrial ablation, uterine artery embolisation, and myomectomy. Under the Montgomery standard, a woman considering hysterectomy must be advised of these alternatives and their respective risks and benefits before consenting to surgery.
Failure to obtain properly informed consent
The risks of hysterectomy — ureteric and bladder injury, bowel injury, haemorrhage, infection, early menopause in premenopausal women undergoing oophorectomy, and failure to resolve symptoms — must be disclosed before surgery.
Post-operative haemorrhage not managed
Post-operative bleeding requiring return to theatre, and failure to identify and manage post-operative haemorrhage promptly, can cause serious harm.
Unnecessary hysterectomy
Where hysterectomy was performed without adequate indication, or where an alternative treatment that the patient would have chosen was not offered, a claim may be available.
SCRIPT 61 — Endometriosis Misdiagnosis Claims
Frequently asked questions
Can I claim for ureter damage during a hysterectomy?
Yes — if the injury resulted from surgical technique below the required standard, or if it was not identified at the time of surgery.
Can I claim if I was not told about alternatives to hysterectomy?
Yes — if the alternatives (endometrial ablation, IUS, uterine artery embolisation) were not discussed and you would have chosen one of them, a consent-based claim under Montgomery may be available.
Can I claim if I had an unnecessary hysterectomy?
Possibly — if the clinical indication for hysterectomy was not met and the procedure was performed without adequate justification, or if proper alternatives were not offered first.