Pneumothorax as a complication of laparoscopic inguinal hernia repair

Abstract

Pneumothorax was identified as a complication of endoscopic hernia repair in two patients with insufflation pressures of 15 mmHg and operating times exceeding 2 h. These patients also showed intraoperative perturbations in both oxygen saturation and end-tidal CO2 production. A prospective study was undertaken to determine whether similar complications would arise if preperitoneal insufflation pressures were limited to 10 mmHg. Postoperative chest x-rays were obtained on all patients to check for pneumothoraces, even clinically occult ones. Fifty patients were studied, with average operating times of 67 min. No patient demonstrated any hemodynamic or ventilatory changes, and none had any evidence of pneumothorax on x-ray. We conclude that these complications were not present when insufflation pressure was maintained at 10 mmHg and that routine x-ray is not warranted. Larger randomized trials of insufflation pressures are needed.

Circulatory and Respiratory Complications of Carbon Dioxide Insufflation

“…Occasionally, however, pneumothorax may develop as a result of CO 2 dissecting and spreading through retroperitoneum or by the extension of a subcutaneous emphysema up to pleura. There are even reports of subcutaneous emphysema after laparoscopic extraperitoneal inguinal hernia repair, which extended and produced pneumothorax and pneumomediastinum [65, 66, 67, 68, 69, 70]. …”

Pneumothorax in Pediatric Patients After Urological Laparoscopic Surgery: Experience With 4 Patients

“…Ferzli et al reported pneumothorax in 2 adult patients undergoing extraperitoneal endoscopic hernia repair with insufflation pressures of 15 mm Hg and operative times greater than 2 hours. 17 To evaluate the impact of lower insufflation pressures, they then used an insufflation pressure of 10 mm Hg in 50 consecutive patients.…”

Delayed pneumomediastinum and pneumothorax complicating laparoscopic extraperitoneal inguinal hernia repair

“…Ferzli et al [7] were the first to describe 2 patients who developed both pneumothorax and pneumomediastinum during bilateral extraperitoneal herniorrhaphy. The 2 patients desaturated and had an increased ETco 2 , while the second patient also developed massive subcutaneous emphysema.…”

“…Harkin et al [1] described a patient who developed a large right pneumothorax during LEPH which was diagnosed intraoperatively because of important respiratory changes. A few other cases were subsequently reported (Table 1) [1,[6][7][8][9][10].…”

“…Increased operating time and a high carbon dioxide insufflation pressure (z15 mm Hg) may result in leakage of gas into the peritoneum [1,7]. However, increasing the duration of the procedure beyond the first 15 minutes of carbon dioxide insufflation has not been shown to affect the carbon dioxide diffusion into the body [5,6].…”