Article Title: Bladder Injury during laparoscopic appendectomy: Detection, management, and learning point for surgical trainees

Authors: Joseph Xavier, Cecile T Pham, Hock Cheah, Kenneth Wong, Shannon Di Lernia

Link: https://pubmed.ncbi.nlm.nih.gov/39845069/

Summary:

I chose this article because laparoscopic appendectomies are one of the most common emergency surgeries performed, and through my OR experiences I developed a solid understanding of how important evidence-based surgical practice is. While common complications include surgical site infection and ileus, iatrogenic bladder injury is a rare but potentially serious event that can significantly impact postoperative outcomes.

This study was a retrospective case series conducted over five years across two regional hospitals, reviewing 1,147 laparoscopic appendectomies. Among these cases, only two bladder injuries were identified, highlighting the rarity of this complication. Both injuries occurred during suprapubic port insertion, were performed by trainees, took place after hours, and were done without an indwelling catheter in place.

Clinically, both patients developed postoperative oliguria and elevated creatinine levels, prompting imaging that confirmed bladder perforation. One case was managed conservatively with catheter drainage alone, while the other required laparoscopic repair. The study emphasizes the importance of recognizing early signs of bladder injury which include abdominal pain, decreased urine output, and rising creatinine. It furthermore highlights a major preventable risk factor namely the absence of bladder decompression prior to suprapubic port placement.

Overall, this article reinforces the importance of meticulous technique during port placement and supports routine bladder decompression to minimize preventable complications during laparoscopic appendectomy.