PNEUMOTHORAX AS A COMPLICATION OF LAPAROSCOPIC INGUINAL-HERNIA REPAIR

Pneumothorax was identified as a complication of endoscopic hernia rep air in two patients with insufflation pressures of 15 mmHg and operati ng times exceeding 2 h. These patients also showed intraoperative pert urbations in both oxygen saturation and end-tidal CO2 production, A pr ospective study was undertaken to determine whether similar complicati ons would arise if preperitoneal insufflation pressures were limited t o 10 mmHg, Postoperative chest x-rays were obtained on all patients to check for pneumothoraces, even clinically occult ones, Fifty patients were studied, with average operating times of 67 min. No patient demo nstrated any hemodynamic or ventilatory changes, and none had any evid ence of pneumothorax on x-ray, We conclude that these complications we re not present when insufflation pressure was maintained at 10 mmHg an d that routine x-ray is not warranted. Larger randomized trials of ins ufflation pressures are needed.