Surgical Emphysema as a Cause of Severe Hypercapnia during Laparoscopic Surgery

Critchley, Lester A. H.; Ho, Alexander

doi:10.1177/0310057x1003800622

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…It was reported in both in intra and extra-peritoneal laparoscopy such as renal and colorectal surgery [7]. The incidence ranges from 0.43% to 2.34% [3]. However, it is thought to be more if carefully assessed.…”

Section: Epidemiologymentioning

confidence: 99%

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Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

Elsaady¹

2018

Austin J Surg

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Laparoscopic surgery has expanded its horizon tremendously. It has been the preferred approach in many operations. Massive subcutaneous emphysema is a rare unique complication of laparoscopic surgery. Here, we report two cases that developed progressive extensive subcutaneous emphysema after laparoscopic cholecystectomy. On reviewing the literature, we found that the incidence ranges from 0.43% to 2.34%. There are many risk factors that have been implicated for its development including; pneumo-peritoneum of more than 200 minutes, and insufflation of CO 2 at pressure more than 15mm Hg, & PETCO 2 more than 50 mmHg. Clinically, subcutaneous emphysema produces an unusual crackling sensation on palpation and graded into four grades according to the severity.The patients should be monitored closely for any cardio-respiratory changes and positive pressure ventilation should be continued until normocarbia is established and signs of respiratory distress & upper airway obstruction are absent. Although conservative supportive measures and close follow up are the only needed strategy in most of cases, however surgical drainage may be beneficial in some case. This achieved either incisions (infraclavicular or submandibular) or tube drainage through different techniques.

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Section: Epidemiologymentioning

confidence: 99%

“…It has been the preferred approach in many operations [2]. Massive subcutaneous emphysema is a rare unique complication of laparoscopic surgery [3], that terrifies the patient& surgeon especially if the surgeon doesn`t have any experience in similar cases. We report here such a complication after laparoscopic cholecystectomy in two cases.…”

Section: Introductionmentioning

confidence: 99%

Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

Elsaady¹

2018

Austin J Surg

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“…[ 11 46 ] However, this can be corrected by the use of mechanical ventilation. [ 47 ] SE may be associated with pneumomediastinum or pneumothrorax by the subcutaneous dissection of CO 2 through the pre-fascial planes. Conversely, pneumomediastinum or pneumothorax may also lead to SE.…”

Section: Subcutaneous Emphysemamentioning

confidence: 99%

Laparoscopy in trauma: An overview of complications and related topics

Kindel

Latchana

Swaroop

et al. 2015

Int J Crit Illn Inj Sci

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The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events.

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“…During laparoscopic surgery, peritoneal insufflation of carbon dioxide (CO 2 ) induces several hemodynamic changes: increased mean arterial pressure, systemic and pulmonary vascular resistance, and reduced cardiac output [5]. In addition, increased CO 2 and peritoneal pressure adversely affected respiratory function by causing hypercarbia and reduced pulmonary ventilation [6]. It is controversial whether LG is useful for patients with poor physical status, although several single-institutional studies have supported the feasibility of LG in patients with pulmonary disease, heart disease, or poor physical status as compared with open gastrectomy (OG) [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of laparoscopic gastrectomy for patients with poor physical status: a retrospective cohort study based on a nationwide registry database in Japan

et al. 2019

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Background Laparoscopic gastrectomy (LG) is an established minimally invasive procedure for gastric cancer. However, it is controversial whether LG is useful for patients with poor physical status classified into higher classes of the American Society of Anesthesiologists physical status (ASA-PS) classification. The aim of this study was to determine the feasibility of LG in patients with ASA-PS class ≥ 3. Methods We extracted data for a total of 28,160 patients with an ASA-PS class ≥ 3 who underwent distal or total gastrectomy for gastric cancer between January 2013 and December 2017 from the National Clinical Database Japan society for gastroenterological surgery registry. We developed a propensity score model from baseline demographics and comorbidities and matched patients undergoing LG to those undergoing open gastrectomy (OG) using a 1:1 ratio. Mortality and morbidities (within 30 days and in-hospital) were compared between the 6998 matched patient pairs. Results In-hospital mortality was significantly lower in patients undergoing LG than in those undergoing OG (2.3% vs. 3.0%, p = 0.01), while the 30-day mortality was similar (1.6% vs. 1.5%). The length of hospital stay was significantly shorter in the LG group (median, 14 days vs. 17 days, p < 0.001). The LG group had a significantly lower incidence of postoperative complications in patients with any grade complication (20.3% vs. 22.5%, p = 0.002) as well as those with ≥ grade 3 complications (8.7% vs. 9.8%, p = 0.03). Conclusion LG was associated with decreased in-hospital mortality and a lower incidence of several postoperative complications when compared to OG among patients with poor physical condition.

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Surgical Emphysema as a Cause of Severe Hypercapnia during Laparoscopic Surgery

Cited by 11 publications

References 19 publications

Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

Laparoscopy in trauma: An overview of complications and related topics

Feasibility of laparoscopic gastrectomy for patients with poor physical status: a retrospective cohort study based on a nationwide registry database in Japan

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