BACKGROUND: Since 1995, litigation following surgical procedures has cost the National Health Service (NHS) over 1 billion GBP (1.5 billion USD). 75,000 groin hernia operations are performed annually in the UK. Despite it being the most commonly undertaken general surgical operation, no study has examined litigation claims in the UK following groin hernia repairs. We aimed to analyse the trends and relationships of litigation claims related to groin hernia surgery in an attempt to improve patient care.METHODS: Data from the NHS Litigation Authority of all claims made from 1995 was analysed. Cases were grouped according to type of repair, cause of claim, injury sustained and outcome of claim.RESULTS: In total 351 claims were made. By the end of 2007, 296 cases had been settled, of which 139 (47.0 per cent) were in favour of the claimant. The total cost to the NHS was 7.3m GBP (11.2m USD). Testicular injury and chronic pain was a feature in 40 per cent of all claims. Visceral and vascular injuries and injuries requiring corrective procedures were the only predictors of a successful claim (p=0.029 and p=0.001 respectively). Claims against visceral and major vessel injuries were more likely to be successful in laparoscopic than open repairs (p=0.019). Chronic pain resulted in the highest average payout of 84,000 GBP (129,000 USD) (Figure).CONCLUSION: Patients should be fully informed of the incidence of testicular injury and chronic pain during the consent process. Approaches minimising visceral and vascular injury particularly in laparoscopic repair should be adopted to reduce litigation and improve patient care.