LAPAROSCOPIC EXTRAPERITONEAL INGUINAL-HERNIA REPAIR COMPLICATED BY SUBCUTANEOUS EMPHYSEMA

The case of a healthy 59-yr-old man who underwent elective laparoscopi c extraperitoneal inguinal hernia repair and general anaesthesia is pr esented. After one hour of surgery, a sudden increase in the FETCO(2) from 5.0% to 9.4% in relation to a massive subcutaneous emphysema, but without any haemodynamic instability, was noticed. The acute rise of FETCO(2) was the first sign of an abnormal event. Nevertheless, subcut aneous emphysema was diagnosed with chest wall examination and palpati on. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperiton eal surgery, since insufflated CO2 can diffuse easily into the surroun ding tissues. High insufflation pressures will increase chances of thi s occurring and was the most likely cause of this complication. This c ase encouraged us to make recommendations for the management of laparo scopic extraperitoneal surgery which included monitoring of CO2 insuff lation pressure, routine examination and palpation of chest wall use o f N2O with caution, adjusting ventilation to physiological FETCO(Z) an d excluding other causes of subcutaneorcs emphysema and hypercarbia.