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Bowel perforations during abdominal liposuction procedures are rare but are a well described complication with risk factors that must be considered.

The following information and recommendations are being shared with all facilities in the spirit of learning and improving patient safety.

The Non-Hospital Medical and Surgical Facilities Patient Safety Incident Review Panel recently reviewed two patient safety incidents involving bowel perforation following a liposuction procedure at a non-hospital facility.

The following contributory factors and observations were considered by the panel:

• The literature suggests that patients with previous surgery and scar or hernia are at higher risk.  
  • One patient had previous cryolipolysis with scar described in the operative note.
  • One patient had previous abdominoplasty.
• These previous surgeries make the tissue planes less apparent and, in some cases, may be obliterated which makes perforation of the abdominal wall more likely as the “feel” of the infiltration or suction cannulae is distorted.  
• The infiltration cannula is smaller and less blunt increasing the risk.
• Risk may be higher with power assisted procedures due to cannula reciprocal and to/forth movements.

In reviewing the potential impact of the contributory factors on the patient safety incidents the following recommendations should be considered: 

• As the infiltration cannula is smaller and less blunt, additional care should be taken for the infiltration portion of the operation.
• Surgeons must be extra careful and vigilant when doing abdominal liposuction in someone with previous abdominal surgery including abdominoplasty and if hernia is suspected or present.