Xavier Joseph, Pham Cecile T, Cheah Hock, Wong Kenneth, Di Lernia Shannon
Department of General Surgery, Gosford Hospital, Gosford, Australia.
Department of Urology, Northern Beaches Hospital, Frenchs Forest, Australia.
Surg Pract Sci. 2022 Mar 27;9:100075. doi: 10.1016/j.sipas.2022.100075. eCollection 2022 Jun.
Laparoscopic appendectomy is one of the most common emergency surgeries. There is a paucity in the literature regarding the incidence and management of iatrogenic bladder injuries. We reviewed a series of iatrogenic bladder injuries during laparoscopic appendectomy to determine incidence, preventable risk factors and management.
We performed a retrospective review of laparoscopic appendectomy at two large regional teaching hospitals over a five-year period from February 2014 to February 2019. The outcomes measured included intra-operative data, such as type of port used and surgeon experience, incidence of iatrogenic bladder injury, mechanism and time of bladder injury recognition, management and clinical outcome.
A total of 1147 patients underwent laparoscopic appendectomy. Two iatrogenic bladder injuries secondary to port placement were identified (0.17%). Both procedures were performed after-hours by surgical trainees. There was no previous history of abdominal surgery. Neither patient had an indwelling catheter (IDC) during the procedure. There were no other visceral or major vascular injuries. Both bladder injuries were identified in the early post-operative period. One case was managed conservatively, whilst the other required laparoscopic repair of the bladder perforation.
Bladder injury should be suspected in patients with abdominal pain, elevated creatinine and anuria following laparoscopic surgery. Although iatrogenic bladder injury during laparoscopic appendectomy is rare, it has the potential for considerable patient morbidity. Therefore, adequate laparoscopic supervision and specific counselling on port access injuries for surgical trainees, adequate bladder decompression with an IDC, and early detection and management guided by the location of injury are essential.
腹腔镜阑尾切除术是最常见的急诊手术之一。关于医源性膀胱损伤的发生率及处理，文献报道较少。我们回顾了一系列腹腔镜阑尾切除术中的医源性膀胱损伤病例，以确定其发生率、可预防的危险因素及处理方法。
我们对2014年2月至2019年2月期间两家大型区域教学医院进行的腹腔镜阑尾切除术进行了回顾性研究。测量的结果包括术中数据，如使用的端口类型和外科医生的经验、医源性膀胱损伤的发生率、膀胱损伤的识别机制和时间、处理方法及临床结果。
共有1147例患者接受了腹腔镜阑尾切除术。发现2例因端口放置导致的医源性膀胱损伤（0.17%）。这两台手术均由外科实习生在非工作时间进行。既往无腹部手术史。术中两例患者均未留置导尿管（IDC）。无其他内脏或大血管损伤。两例膀胱损伤均在术后早期被发现。1例采用保守治疗，另1例需要腹腔镜修复膀胱穿孔。
腹腔镜手术后出现腹痛、肌酐升高和无尿的患者应怀疑膀胱损伤。虽然腹腔镜阑尾切除术中医源性膀胱损伤很少见，但它有可能给患者带来相当大的发病率。因此，对实习外科医生进行充分的腹腔镜操作监督和关于端口穿刺损伤的具体指导、使用IDC进行充分的膀胱减压，以及根据损伤部位进行早期检测和处理至关重要。
