Wallace Lauren, Leigh Ya'acov
Department of General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Surgery, Wimmera Base Hospital, Horsham, Victoria, Australia.
J Surg Case Rep. 2023 Mar 14;2023(3):rjad146. doi: 10.1093/jscr/rjad146. eCollection 2023 Mar.
Increasing utilization of a laparoscopic total extraperitoneal (TEP) approach for inguinal hernia repairs has led to rare complications. We describe a rare case of subcutaneous emphysema, pneumomediastinum and pneumothorax following a laparoscopic TEP inguinal hernia repair in a 29-year-old male. Mechanisms posited include extraperitoneal carbon dioxide migration via the retroperitoneal space and dissection along the fascia transversalis and endothoracic fascia anteriorly to enter the mediastinum. Intra-operatively the patient coughed vigorously, potentially propagating the extent of extraperitoneal gas dissection and exacerbating these complications. Given the potential morbidity, it is important for surgeons and anaesthetists to recognize these complications.
腹腔镜完全腹膜外（TEP）入路用于腹股沟疝修补术的应用日益增加，导致了一些罕见的并发症。我们描述了一例29岁男性在腹腔镜TEP腹股沟疝修补术后发生皮下气肿、纵隔气肿和气胸的罕见病例。推测的机制包括腹膜外二氧化碳通过腹膜后间隙迁移，并沿着腹横筋膜和胸内筋膜向前分离进入纵隔。术中患者剧烈咳嗽，可能使腹膜外气体分离范围扩大并加重了这些并发症。鉴于其潜在的发病率，外科医生和麻醉医生认识到这些并发症很重要。
