Bladder injury during laparoscopic appendectomy: Detection, management, and learning point for surgical trainees

Area of Science:

• Surgical Innovation
• Patient Safety
• Minimally Invasive Surgery

Background:

• Laparoscopic appendectomy is a common emergency procedure.
• Iatrogenic bladder injuries during this surgery are infrequently documented.
• Understanding incidence and risk factors is crucial for prevention.

Purpose of the Study:

• To determine the incidence of iatrogenic bladder injuries during laparoscopic appendectomy.
• To identify preventable risk factors associated with these injuries.
• To review the management and outcomes of bladder injuries.

Main Methods:

• Retrospective review of 1147 laparoscopic appendectomies over five years.
• Data collected included port type, surgeon experience, and injury details.
• Analysis of injury recognition, management, and clinical outcomes.

Main Results:

• Two iatrogenic bladder injuries (0.17%) occurred, both related to port placement.
• Injuries happened during after-hours procedures performed by surgical trainees.
• Both injuries were identified post-operatively; one managed conservatively, the other surgically.

Conclusions:

• Iatrogenic bladder injury during laparoscopic appendectomy, though rare, can lead to significant patient morbidity.
• Key preventative measures include enhanced supervision for trainees, counseling on port access risks, and ensuring adequate bladder decompression.
• Early detection and management tailored to injury location are essential for optimal outcomes.