On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?
BACKGROUND
Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention.


METHODS
A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined.


RESULTS
During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically.


CONCLUSIONS
Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication.
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Gregory J
GJ
Nason
Sher N
SN
Baig
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Matthew J
MJ
Burke
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Asadullah
A
Aslam
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Michael E
ME
Kelly
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Leon G
LG
Walsh
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Hugh D
HD
Flood
Department of Urology, University Hospital Limerick, Limerick, Ireland.
Subhasis K
SK
Giri