Laparoscopic management of bladder injury during total laparoscopic hysterectomy

Abstract

Purpose Iatrogenic bladder injury remains a major challenge. We compared the success and reliability of laparoscopic repair of intraperitoneal bladder rupture in patients who had undergone total laparoscopic hysterectomy. Methods This retrospective study included patients who underwent total laparoscopic hysterectomy for benign gynaecological cases at a tertiary academic hospital between January 2018 and June 2019. All patient medical records included in the study were reviewed, and the causes, incidence and management of bladder injuries were assessed. Results There were nine patients. The cause of all the ruptures was iatrogenic, and all were intra-operatively detected. In all patients, bladder injuries occurred in the posterior side of the bladder during vesicouterine dissection. Laparoscopic bladder perforation repair was performed successfully in all patients. No major complications had occurred in any patients after surgery. The foley catheters were removed 6.67 +/- 0.7 (5-7) days after surgery. Conclusions If performed by well-trained laparoscopic surgeons, laparoscopic hysterectomy could be the best option for appropriate patients. Nevertheless, patients should be well aware of the potential complications in endometriosis and caesarean cases before the procedure, and care should be paid during dissection. When a urogenital injury is suspected or detected the condition must be adequately identified and proper treatment must be performed to avoid postoperative complications and long-term morbidity.