Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery

Background: Pneumomediastinum can be a sign of esophageal perforation. Duri ng laparoscopic esophageal surgery, the mediastinum is exposed to carbon di oxide gas under pressure that can cause pneumomediastinum. Methods: Forty-five patients undergoing laparoscopic esophageal procedures had erect, inspiratory, single-view chest radiographs (CXR) performed in th e recovery room (RR). Patients with extraabdominal gas underwent daily erec t, inspiratory, single-view CXR until resorption of the gas or discharge fr om the hospital. Insufflation time and pressure were recorded, and morbidit y was evaluated. Results are expressed as mean +/- SEM. Results: Twenty-five mens (56%) and 20 women (44%) aged 33.0 +/- 2.9 years underwent 10 Heller myotomies (22.2% ), 27 Nissen fundoplications (60.0%), six Toupet fundoplications (13.3%), a nd two paraesophageal hernia repairs (4.4%). Twenty-four patients (53.3%) h ad normal CXR in RR, and 21 (46.7%) had extraabdominal gas. Eighteen (85.7% ) of the 21 had pneumomediastinum, three (14.3%) had pneumothorax, and 12 ( 57.1%) had subcutaneous emphysema in RR. Sixteen of these 21 remained hospi talized and had repeat CXR on postoperative day 1. Of these 16, five (31.3% ) had normal CXR, 11 (68.8%) had pneumomediastinum, and seven (43.8%) had s ubcutaneous emphysema. There were no esophageal perforations and no chest t ube insertions, and there was no morbidity related to pneumomediastinum. Conclusion: Pneumomediastinum is observed frequently following laparoscopic esophageal operations and often persists past 24 h. After these operations , pneumomediastinum is not necessarily indicative of esophageal perforation . In this group, it caused no clinically significant events that altered th e course of the patients.