Practice of Medicine


Reducing the Risks of Bowel Perforation/Injury During Cholecystectomy

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Bowel perforations/injuries during cholecystectomy account for 3% of medical malpractice claims among general surgeons insured by MagMutual. Bowel perforation is a rare complication of laparoscopic cholecystectomy that can have significant and even fatal consequences to patients if left undiagnosed.

To help general surgeons reduce the occurrence of bowel perforation/injury during cholecystectomy, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to this injury and developed strategies to improve patient outcomes.

Top Risks

The main causes of claims related to bowel perforation/injury during cholecystectomy are:

  • Improper technique
  • Failure to recognize a complication 

            Top Strategies for Reduction

            Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

            Clinical strategies

            • If dense adhesions are present and progress is limited, consider converting to an open procedure, inserting cholecystostomy tube or partial (sub-total) cholecystectomy.
            • When dissection has been difficult, carefully inspect the dissected tissue at completion of the procedure to evaluate for possible injury to intestine.
            • Always consider bowel injury when a patient complains of inordinate post-operative pain, and order appropriate studies for work-up.

            Operational strategies

            • Clearly document the informed consent process, including discussion with patient about potential risks and complications from the procedure and factors that may require conversion to an open procedure.
            • Procedural documentation should include any encountered challenges in the procedure (such as inflammation obscuring the anatomy).

                Other Top Risks

                Although bowel perforations account for a significant number of claims among general surgeons according to our data, we’ve identified several other drivers of loss based on claims frequency:

                Risk Drivers by Top Cause
                Key Loss DriverTop Clinical Loss CauseTop Non-Clinical Contributing Factor% of Claims
                (A) Common bile duct injury during cholecystectomyProceduralDocumentation6%
                (B) Medication errorTreatmentDocumentation4%
                (C) Bowel perforation/injury during cholecystectomyProceduralCommunication3%
                (D) Anastomotic leak following colon resectionProceduralCommunication2%
                (E) Arerial injury during vascular surgeryProceduralDocumentation2%
                (F) Bowel perforation/obstruction following laparoscoptic/robotic hernia surgeryProceduralCommunication2%
                Risk Drivers by Frequency


                Download the full report with indemnity payment information and strategies for all the key loss drivers to help you reduce risk in the top areas that claims occur.

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                Data Collection & Methodology

                Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.


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                The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.