Anestéziológia a intenzívna medicína 2/2015

Pneumothorax during laparoscopic procedure – rare complication, we are ready to cope with it?

This case report describes pneumothorax as a complication of laparoscopic Nissen fundoplication in male patient admitted in our hospital FNsP J. A. Reimana, Prešov. During the surgery when patient was in general anaesthesia pneumothorax developed and was treated by thoracocenthesis and drainage. As a diagnostic tool for its verification was also used ultrasonograph available on central surgery tract. In discussion authors next compare incidence, etiology, pathogenesis and treatment options of pneumothoraces occurred during laparoscopic surgery. In the summary authors on the basis of literature review give guidelines for rapid identification and correct management of this potentially life threatening condition. Crucial fact is that pneumothorax is not a rare complication of laparoscopic surgery and most cases are caused by accumulation of CO 2(kapnothorax) which penetrates from abdominal cavity. This gas has fortunately a great tendency to resorb spontaneously during few minutes. Given that there is enough to use less invasive measures to handle this complication. These measures include use of positive end expiratory pressure and higher inspiratory oxygen concentration during artificial ventilation and also decreasing of intraabdominal pressure during kapnoperitoneum using of which we can avoid the need of thoracocenthesis and following drainage.

Keywords: pneumothorax, kapnothorax, laparoscopic surgery, fundoplication, thoracical drainage.