Laparoscopic repair of bladder injury and laceration

The management of bladder injuries at laparoscopy is controversial. Some endoscopists believe in mandatory open repair, whereas others recommend laparoscopic cystotomy repair. We performed laparoscopy to treat two women with bladder injury, one with excision of a transmural nodule of bladder endometriosis, and the other with incidental cystotomy during adenexectomy in the presence of obliterative adhesions. After localizing the injury to the dome of the bladder remote from ureters, the edges of the injury were cleaned of damaged tissue and apposed in two layers using interrupted 4-0 polydioxanone endocorporeal sutures. The patients had an uneventful postoperative course, and neither experienced bladder function problems. We conclude that applying the already established tenets of bladder injury repair by laparotomy to laparoscopic procedures is acceptable in most endoscopic settings.