Prevention and management of related complication due to laparoscopic operation: Pneumothorax, pneumomediastinum and subcutaneous emphysema

Abstract

Essential prerequisite of laparoscopic operation is establishing and maintaining pneumoperitoneum with a certain pressure. But under certain circumstances CO2-gas insufflating could induce pneumothorax, pneumomediastinum and subcutaneous emphysema during the operation. to probe the mechanism of the above complications. 2 typical cases were reported with attempt to probe the mechanism of the development of such applications. We believe that high intra-abdominal pressure during operation is the primary cause of the complications. The essentials of prevention and management of such complications were proposed.

Embryological, anatomical and clinical considerations on pleuroperitoneal communication

“…Pneumothorax is also a rare complication of laparoscopic operations, providing evidence for PPC [ 26 , 51 , 52 ]. PPC can be either pre-existing or may develop during surgery.…”

“…PPC can be either pre-existing or may develop during surgery. Pre-existing PPC occurs when the CO 2 gas passes from the abdomen to the thorax through congenital pores or hiatus of the diaphragm [ 51 , 52 ]. Acquired PPC occurs when the diaphragm is injured either by the surgeon or by the increased pressure of abdominal gas [ 51 , 52 ].…”

“…Pre-existing PPC occurs when the CO 2 gas passes from the abdomen to the thorax through congenital pores or hiatus of the diaphragm [ 51 , 52 ]. Acquired PPC occurs when the diaphragm is injured either by the surgeon or by the increased pressure of abdominal gas [ 51 , 52 ]. The reverse-Trendelenburg position of the patient may contribute to the pathogenesis because the liver and the omentum are positioned downwards, exposing the right hemidiaphragm and its possible defects [ 52 ].…”