Several years ago, I was faced with a challenging repair of a bladder injury. Upon completing the closure, I questioned the integrity of the tissues. To complicate matters, this patient also had an adjacent vaginal suture line. Inserting tissue between these structures could reduce the risk of the bladder healing abnormally to adjacent structures (fistula formation). However, the usual anatomic candidates were not readily available (such as omentum).
After careful consideration, I fashioned a large flap of peritoneum – the thin lining of the abdomen – and mobilized it such that it would completely cover the bladder. I have since utilized this method for countless complex reconstructive surgeries – whether using laparoscopic, robotic, or even open surgical techniques. Necessity is often the mother of invention.
The thin peritoneal lining is surprisingly sturdy and vascular. It also has some inherent healing and anti-infective properties. Most importantly, it is almost always readily available.