We present a case of 100% pneumothorax in a 41-yr- The higher mortality and protracted hospital stay from laparotomy, and the recent improvement in instrumentation, have increased the popularity of laparoscopy, i Laparoscopy has been extended to include appendicectomy, inguinal hernia repair, laparoscopic nephrectomy, splenectomy, hemicolectomy, and in our case Nissen fundoplication. 2 The use of laparoscopy has eliminated the upper abdominal incision, and the impairment of pulmonary mechanics and ventilation. 3 Consequently, patients can be discharged from the hospital earlier. We report the complication of left pneumothorax which occurred during laparoscopy for Nissen fundoplication. The pneumothorax was caused probably by a rent in the diaphragm during the procedure permitting gas to enter the left chest. Case reportThe patient was a 41-yroold, 97-kg man undergoing laparoscopic Nissen fundoplication for gastritis, gastroesophageal reflux, and a hiatal hernia. His physical examination and laboratory values were within normal limits. Medications included ranifidine 150 mg po twice daily.Generalanaesthesia was induced with thiopentone 500 mg/v followed by succinylcholine 120 mg/v to facilitate tracheal intubation with an 8.0 millimeter cuffed tracheal tube. Anaesthesia was maintained with oxygen and nitrous oxide in a 1:3 ratio and 1.5% inspired isoflurane. The patient also received atracurium 50 mg/v for maintenance of neuromuscular blockade. Monitors included blood pressure, end-tidal carbon dioxide, ECG, oximetry, and nerve stimulator.Abdominal insufflation was performed with carbon dioxide and the trocars were placed uneventfully. The patient was placed in a 30 ~ reverse Trendelenburg position to assist with surgical exposure. The peak inspiratory CAN J ANAESTH 1994 / 41:9 / pp 854--6

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