Pneumothorax during laparoscopic Nissen fundoplication

Abstract

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

Pneumothorax during laparoscopy

“…Gases such as He have been used to a limited extent in clinical laparoscopic surgery [7]. The metabolic derangement that can be a consequence of CO 2 pneumoperitoneum is not seen with He pneumoperitoneum due to the lack of absorption of this inert gas.…”

“…It is most commonly seen after laparoscopic esophageal surgery, in which dissection of the esophageal hiatus puts the thoracic parietal pleura at risk particularly on the left side [7,10]. Risk factors that have been correlated with the development of a pneumothorax during laparoscopic surgery include operative times more than 200 min, positive endtidal CO 2 >50 mmHg, and operator inexperience [2,8].…”

“…It is most commonly seen after laparoscopic mobilization of the esophagus in procedures such as fundoplication [10]. Pneumothorax during abdominal laparoscopic surgery may cause paradoxical ballooning of the hemidiaphragm, a decrease in lung compliance, deoxygenation, and hypercarbia [2,7]. A large-volume pneumothorax can also cause hemodynamic instability and require active management [3].…”

Anesthesiological hazards during laparoscopic transhiatal esophageal resection: a case control study of the laparoscopic-assisted vs the conventional approach

“…It has not yet been determined whether there are significant changes after pleural entry in minimally invasive esophageal cancer surgery. But there are studies attesting to the cardiopulmonary changes after intraoperative pleural entry during laparoscopic antireflux surgery [5,6].…”

Reflü Cerrahisi Sonrası Görülen Basınçlı Hidropnömotoraks

“…Bazen bu komplikasyonlar sonucunda ölüm dahi görülebilmektedir. Pnömotoraks, laparoskopik Nissen fundoplikasyonu sonrası gelişebilen bir komplikasyondur (1). Bu komplikasyonun görülme sıklığı %1' dir ve genellikle solda olmakla birlikte tecrübeli ellerde daha da azalmıştır (2).…”