On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

Abstract

55case series AbstractIntroduction: 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. Conclusion: 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. IntroductionAppendicectomy is the most common emergency surgical procedure performed worldwide.1 Laparoscopy plays a valuable role in the management of patients with acute lower abdominal pain. A Cochrane review has recommended laparoscopy and laparoscopic appendicectomy (LA) in patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible.2 Minimally-invasive approaches have revolutionized surgery.3 Laparoscopic surgery has well-documented benefits with associated shorter length of stay, quicker return of bowel function, decreased analgesic requirements, lower rates of wound complications, and improved cosmesis.4,5 Furthermore LA is seen as an excellent training opportunity and evidence shows an attainable learning curve.6 LA is a safe procedure for junior trainees to perform; 7-9 however resident involvement in LA has resulted in increased operative time and complications. 10,11The overall rate of major complications following a laparoscopic procedure is about 1.4 per 1000 procedures. 12However, the incidence of port site complications following laparoscopic surgery is around 21 per 100 000 cases.13 Port site complications can be grouped into access-related complications (vascular or visceral injuries) 14 and postoperative complications (wound infection or port site herniation). 15,16Currently, there is little data regarding iatrogenic secondary trocar induced injuries in LA. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. MethodsWe performed a retrospective analysis of LA over a 2-year period (2012)(2013) at a tertiary referral university teaching hospital. Data were obtained from the hospital in-patient enquiry (HIPE) system. The outcomes measured included the incidence of iatrogenic bladder injuries at the time of LA, mode and time of clinical presentation, type of port used, le...

Postoperative Follow-Up and Recovery after Abdominal Surgery

“…All patients undergoing medium and major abdominal surgery usually have a urinary catheter placed under anesthesia [23]. Catheter placement should be performed under sterile conditions, usually in preanesthetic room or on-table [24] to avoid infection, bladder injury during surgery, and to accurately monitor renal function during surgery. There are numerous causes of acute kidney injury or otherwise low urine output in the perioperative period, the risk being reported up to 5-10% in surgical patients [25].…”