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Koliakos N, Papaconstantinou D, Tzortzis AS, Schizas D, Bistarakis D, Bakopoulos A. Pneumothorax as a rare complication during laparoscopic total extra-peritoneal inguinal hernia repair: A case report and review of the literature. J Minim Access Surg 2021; 17:385-388. [PMID: 34045398 PMCID: PMC8270041 DOI: 10.4103/jmas.jmas_34_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal repair are the two most commonly performed types of laparoscopic hernia repair procedures. Herein, we present a rare case of pneumothorax and pneumomediastinum that ensued during a TEP inguinal hernia repair. A 73-year-old man presented for elective laparoscopic right-sided hernia repair. After intubation, a 10-mm and two 5-mm trocars were placed in the peri-umbilical and midline area, respectively. A balloon dissector was inserted from the 10-mm trocar to develop the retro-rectus space and carbon dioxide was insufflated up to a pressure of 14 mmHg. About 55 min after insufflation, the patient presented subcutaneous emphysema, oxygen saturation dropped from 100% to 96% and pCO2 increased to 55 mmHg. Due to concerns for pulmonary embolism, he immediately underwent a chest computed tomography, which revealed pneumothorax, pneumomediastinum and subcutaneous emphysema extended throughout the neck, thorax and upper abdomen. The patient was successfully treated conservatively with oral analgesia and supplemental oxygen and was discharged on the 4th post-operative day without any further complications.
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Affiliation(s)
- Nikolaos Koliakos
- 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrianos-Serafeim Tzortzis
- 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Medical School, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Bistarakis
- 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Zhi-Fu W, Nian-Cih H, Hou-Chuan L, Yu-Ting H. Delayed subcutaneous emphysema in an acute weight loss female following robotic surgery. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.4103/jmedsci.jmedsci_6_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chaparro Mendoza K, Cruz Suarez G, Suguimoto A. Crisis anestésica en cirugía laparoscópica: neumotórax espontáneo bilateral. Diagnóstico y manejo, reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chaparro Mendoza K, Cruz Suarez G, Suguimoto A. Anesthesia crisis in laparoscopic surgery: Bilateral spontaneous pneumothorax. Diagnosis and management, case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Anesthesia crisis in laparoscopic surgery: Bilateral spontaneous pneumothorax. Diagnosis and management, case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543020-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Teng TY, Lau CCL. Unusual cause of pneumomediastinum in a laparoscopic extraperitoneal inguinal hernia repair. J Surg Case Rep 2014; 2014:rju106. [PMID: 25348336 PMCID: PMC4209375 DOI: 10.1093/jscr/rju106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pneumomediastinum is an extremely rare complication after laparoscopic inguinal hernia repair. Very few cases have been reported in the surgical literature to date and most reports indicate pneumoperitoneum from the transabdominal preperitoneal approach as a causative factor. This case report describes a patient in whom an elective total extraperitoneal inguinal hernia repair was complicated by a pneumomediastinum without concomitant pneumoperitoneum, and identifies the tracking of air along the anterior extraperitoneal space and endothoracic fascia as a cause. Previous case reports were reviewed and possible etiologies are discussed.
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Sucandy I, Kolff JW. Pneumothorax after Laparoscopic Extraperitoneal Inguinal Hernia Repair: A Potential Complication that Every General Surgeon Should Know. Am Surg 2012. [DOI: 10.1177/000313481207800205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Iswanto Sucandy
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
| | - Jeffrey W. Kolff
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
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Kim HY, Kim TY, Lee KC, Lee MJ, Kim SH, Bahn JM, Choi EK, Kim JY. Pneumothorax during laparoscopic totally extraperitoneal inguinal hernia repair -A case report-. Korean J Anesthesiol 2010; 58:490-4. [PMID: 20532060 PMCID: PMC2881527 DOI: 10.4097/kjae.2010.58.5.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/26/2010] [Accepted: 05/01/2010] [Indexed: 11/10/2022] Open
Abstract
We experienced an extremely rare complication during performance of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair for a 57-year-old healthy man. About 50 minutes after CO2 insufflation, the patient developed tachycardia, hypoxemia, hypercapnia and an increased airway pressure. Right pneumothorax with subcutaneous emphysema was recognized on the emergency chest X-ray and this was successfully treated by chest tube insertion. Anesthesiologists should be aware of the possible occurrence of pneumothorax during laparoscopic TEP hernia repair.
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Affiliation(s)
- Hye Young Kim
- Department of Anesthesiology and Pain Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Zhu Q, Mao Z, Yu B, Jin J, Zheng M, Li J. Effects of persistent CO(2) insufflation during different laparoscopic inguinal hernioplasty: a prospective, randomized, controlled study. J Laparoendosc Adv Surg Tech A 2010; 19:611-4. [PMID: 19845453 DOI: 10.1089/lap.2009.0084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aims of this study were to investigate the effects of carbon-dioxide (CO(2)) insufflation on hemodynamic and respiratory function during laparoscopic inguinal hernioplasty and to evaluate the safety of transabdominal preperitoneal hernia repair (TAPP) and extraperitoneal hernia repair (TEP). MATERIALS AND METHODS Forty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair in our study. The patients were randomly assigned to undergo TAPP (TAPP group, n = 20) or TEP (TEP group, n = 20). Hemodynamic and respiratory parameters, including heart rate, blood pressure, end-tidal CO(2) (EtCO(2)), and blood-gas parameters, were observed and compared between the two groups. RESULTS There was no significant difference between the two groups in terms of sex, age, American Society of Anesthesiology degree, body-mass index, type of hernia, operation time, hospital stay, and postoperative pain score. In both groups, 5 minutes into the operation, blood pressure, EtCO(2), PaCO(2), and HCO(3)(-) increased significantly, whereas heart rate and pH decreased significantly (P < 0.05). The above tendency became significant with the operation prolonged. All parameters recovered to normal levels at the end of surgery. No significant difference was found between the TAPP and TEP groups. CONCLUSIONS Both TAPP and TEP procedures can result in CO(2) accumulation, acidosis, increased blood pressure, and decreased heart rate. But, these effects were transient and could be well controlled by appropriate treatments during the operation. The laparoscopic TAPP and TEP techniques are safe for patients by proper perioperative management.
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Affiliation(s)
- Qianlin Zhu
- Department of Anesthesiology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 or(1=1)-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13:343-403. [PMID: 19636493 PMCID: PMC2719730 DOI: 10.1007/s10029-009-0529-7] [Citation(s) in RCA: 846] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/19/2009] [Indexed: 02/06/2023]
Abstract
The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.
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European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 or(1=2)-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vidović D, Kirac I, Glavan E, Filipović-Cugura J, Ledinsky M, Bekavac-Beslin M. Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications. J Laparoendosc Adv Surg Tech A 2007; 17:585-90. [PMID: 17907968 DOI: 10.1089/lap.2006.0186] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Whereas open Lichtenstein inguinal herniorrhaphy is generally accepted as a safe, well-understood method with a high success rate, the laparoscopic repair of a inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair, many surgeons are not familiar with this technique owing to technical demands and a long learning curve. This study compares the results and complications between open tension-free mesh (Lichtenstein) repair and laparoscopic total extraperitoneal (TEP) repair. The study cohort was comprised of 345 consecutive patients who underwent an inguinal herniorraphy procedure. An open hernia repair was performed on one group of patients (n = 233), whereas TEP repair was performed on the other (n = 112), and then the comparison of intra- and postoperative complications and results obtained from both techniques was done. The mean hospital stay was similar in both groups. The average operative time in the TEP group was 58.6 +/- 18.1 minutes, and the average operative time in the open group was 58.2 +/- 17.8 minutes. There was no difference in postoperative complication rates between the two groups, except for urinary retention, which patients who underwent TEP repair were more likely to get. The following major complications were recorded: 2 cases of urinary bladder perforation-1 during TEP repair and the other during Lichtenstein repair, but both with good postoperative outcome-and 1 case of pneumothorax, which occurred during the TEP procedure. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate.
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Affiliation(s)
- Dinko Vidović
- Department of Surgery, University Hospital, Sisters of Charity, Vinogradska 29, 10000 Zagreb, Croatia.
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Schmidt SC, Langrehr JM. Re: Spray application of fibrin glue as risk factor for subcutaneous emphysema in laparoscopic transabdominal inguinal hernia repair. Surg Laparosc Endosc Percutan Tech 2007; 17:221-2. [PMID: 17581474 DOI: 10.1097/sle.0b013e31806030c6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kumar D, Farrell T, Tierney E. A frightening complication of general anaesthesia for paediatric dental extractions. Pediatr Surg Int 2007; 23:613-6. [PMID: 17211592 DOI: 10.1007/s00383-006-1836-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022]
Abstract
We report a case of eight year old child who developed severe subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitonium in recovery room after apparently uneventful general anaesthesia for eight primary teeth extractions. Causes and treatment of these complications are discussed.
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Affiliation(s)
- D Kumar
- Department of Anaesthesia, Wexford General Hospital, Wexford, Ireland
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Lo CH, Trotter D, Grossberg P. Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair. ANZ J Surg 2005; 75:917-9. [PMID: 16176241 DOI: 10.1111/j.1445-2197.2005.03573.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.
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Affiliation(s)
- Cheng Hean Lo
- Department of Surgery, Box Hill Hospital, Box Hill, Victoria, Australia.
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Bartelmaos T, Blanc R, De Claviere G, Benhamou D. Delayed pneumomediastinum and pneumothorax complicating laparoscopic extraperitoneal inguinal hernia repair. J Clin Anesth 2005; 17:209-12. [PMID: 15896590 DOI: 10.1016/j.jclinane.2004.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Accepted: 05/24/2004] [Indexed: 11/25/2022]
Abstract
A 53-year-old healthy man underwent elective laparoscopic, extraperitoneal, right-sided herniorrhaphy. Postoperatively, he complained of chest pain on inspiration. Chest x-ray and computed tomographic scan revealed a pneumomediastinum and a right-sided pneumothorax. Previous case reports and possible etiologies are reviewed.
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Affiliation(s)
- Tonine Bartelmaos
- Department of Anesthesiology and Critical Care Medicine, Hôspital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
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Sánchez-Etayo G, Ayuso A, Santos P, Tercero FJ, Luis M. Subcutaneous emphysema, pneumomediastinum and pneumothorax after laryngeal laser surgery. Eur J Anaesthesiol 2003; 20:753-4. [PMID: 12974600 DOI: 10.1017/s0265021503211236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Literature Watch. J Laparoendosc Adv Surg Tech A 2000. [DOI: 10.1089/lap.2000.10.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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