Journal of Minimal Access Surgery Medknow Publications ISSN: 0972-9941 EISSN: 1998-3921 Vol. 7, Num. 2, 2011, pp. 162-162

Journal of Minimal Access Surgery, Vol. 7, No. 2, April-June, 2011, pp. 162

Letter to Editor

Laparoscopic bladder injury and ascites

Viroj Wiwanitkit

Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand

Correspondence Address: Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand, wviroj@yahoo.com

Code Number: ma11038

DOI: 10.4103/0972-9941.78360

Dear Sir,

I read the recent report on laparoscopic bladder injury-induced ascites with great interest. ^[1] I would like to share some ideas on this study. There are two main points to be discussed. First, the question of how to prevent laparoscopic bladder injury should be addressed. Good anatomical clarification on the surgical site is necessary for all laparoscopic surgeries. If the case is still doubtful, selection of laparotomy might be more appropriate. Nevertheless, to prevent bladder injury, Hsieh et al. proposed the ′placement of a urethral catheter and syringe-assisted drainage of all urine from the bladder at the beginning of the operation′. ^[2] However, based on good preparation, good instrument, good surgeon and team, a bladder injury can still occur. Hence, it is necessary to re-check, intra-operatively, before making a conclusion that there is no complication. Wu et al. noted that ′early recognition of injuries, preferably intra-operatively, with immediate appropriate treatment is crucial′. ^[3] Second, the laboratory diagnosis on urinary ascites should be discussed. Indeed, as Al-Mandeel et al, observed, it is not necessary that this condition be accompanied with aberrant clinical chemistry results. The diagnosis of ascites must be based on the existence of fluid in the abdominal wall and the analysis of ascetic fluid can be useful for making a definitive diagnosis. ^[4]

References

1.	Al-Mandeel H, Qassem A. Urinary ascites secondary to delayed diagnosis of laparoscopic bladder injury. J Min Access Surg 2010;6:50-2.  Back to cited text no. 1  [PUBMED]
2.	Hsieh MH, Bayne A, Cisek LJ, Jones EA, Roth DR. Bladder injuries during laparoscopic orchiopexy: Incidence and lessons learned. J Urol 2009;182:280-4.  Back to cited text no. 2
3.	Wu MP, Lin YS, Chou CY. Major complications of operative gynecologic laparoscopy in southern Taiwan. J Am Assoc Gynecol Laparosc 2001;8:61-7.  Back to cited text no. 3
4.	White V, Hardwick RH, Rees JR, Slack M. Massive urinary ascites after removal of a supra-pubic catheter: Case report and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:831-3.  Back to cited text no. 4

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