Extra-abdominal pneumodissection after laparoscopic antireflux surgery

The presence of pneumoperitoneum during laparoscopic antireflux surgery can lead to the dissection of carbon dioxide into the mediastinum, retroperito neum, subcutaneous tissues, and neck (pneumodissection). The purpose of thi s study is to describe the incidence, extent, duration and pathways of pneu modissection during laparoscopic antireflux surgery. Twenty patients who un derwent laparoscopic antireflux surgery from August 1998 through May 1999 w ere studied. Physical examination and chest radiographs were performed in t he recovery room and each day postoperatively. Noncontrast computerized tom ography (CT) of the neck, chest, and upper abdomen was also performed on po stoperative day one. Subcutaneous emphysema and radiologic evidence of pneu modissection occurred commonly and typically resolved within 4 days postope ratively. The incidence of pneumomediastinum (85%) seen on CT scan was simi lar to that of pneumodissection into the neck (80%). The most common pathwa y of dissection of gas was through the anterior mediastinum and into the ne ck through the carotid space. Other findings on CT scan revealed pneumoperi toneum in 70 per cent, pneumoretroperitoneum in 10 per cent, and pneumothor ax in 0 per cent. The dissection of gas into the mediastinum, neck, and sub cutaneous tissues is very common after laparoscopic antireflux surgery. Sub cutaneous emphysema on physical examination and radiographic pneumo dissect ion typically resolves within 3 to 4 days. After this time one should consi der the presence of any substantial amount of gas as a potential complicati on related to the procedure.