Controlling intraoperative laparoscopy-induced pneumothorax using a novel technique

Awadh Alqahtani, Mohammad Almayouf, Srikar Billa


Pneumothorax (PTX) is defined as an abnormal accumulation of gas in the pleural space. There is a potential development of PTX during laparoscopy since gas insufflation is used. Management options are available to control PTX intraoperatively, and herein we describe a new technique that can be implemented with unique features. A 32-year-old patient with morbid obesity was scheduled for laparoscopic adjustable gastric band (AGB) removal and laparoscopic sleeve gastrectomy (LSG). During the removal of AGB, a hiatal hernia was noticed. Dissection of the hernia led to PTX. Images were collected from the procedure video to describe our technique in controlling laparoscopy-induced PTX. Upon noticing PTX, actions were taken promptly using our technique. The anesthesia team was alerted, the abdomen was deflated, and the table was positioned to Trendelenburg. The PTX was controlled using a 14fr feeding tube advanced through the dissected esophageal hiatus, with the external end submerged under saline. The procedure was completed with no complications. Our technique in controlling laparoscopy-induced PTX is effective in certain situations. The technique assures completing the procedure without hindrance with minimal morbidity.


Laparoscopy, Hiatal hernia, Pneumothorax, Bariatric surgery

Full Text:



Joshi GPJACoNA. Complications of laparoscopy. 2001;19(1):89-105.

Hahnloser D, Schumacher M, Cavin R, Cosendey B, Petropoulos P. Risk factors for complications of laparoscopic Nissen fundoplication. Surg Endosc. 2002;16(1):43-7.

Joris JL, Chiche J-D, Lamy MLJA, Analgesia. Pneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure. 1995;81(5):993-1000.

Murdock CM, Wolff AJ, Van Geem TJO, Gynecology. Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy. 2000;95(5):704-9.

Watson DI, Mitchell P, Game PA, Jamieson GGJA, surgery NZjo. Pneumothorax during laparoscopic mobilization of the oesophagus. 1996;66(10):711-2.

Wahba RW, Tessler MJ, Kleiman SJJCjoa. Acute ventilatory complications during laparoscopic upper abdominal surgery. 1996;43(1):77-83.

Han Q, Wang B, Xu A. Use of intraoperative ultrasonography for identification and management of pneumothorax caused by iatrogenic diaphragm defect: a case report and literature review. J Int Med Res. 2020;48(1):300060519898048.

Hawasli A, Boutt AWJJoL, Techniques AS. Spontaneous resolution of massive laparoscopy-associated pneumothorax: the case of the bulging diaphragm and review of the literature. 2002;12(1):77-82.

Moore M, Brien KOJA. Carbon dioxide pneumothorax treatment with positive end‐expiratory pressure. 2004;59(6):622-3.

Park HJ, Kim DK, Yang MK, Seo JE, Kwon JH. Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report. Korean J Anesthesiol. 2016;69(1):88-92.

Chui PT, Gin T, Chung SCS. Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy. 1993;48(11):978-81.

Salihoglu Z, Demiroluk S, Demirkiran O, Cakmakkaya S, Aydogan F, Carkman S, et al. The effects of pneumothorax on the respiratory mechanics during laparoscopic surgery. J Laparoendosc Adv Surg Tech A. 2008;18(3):423-7.

Harkin CP, Sommerhaug EW, Mayer KL. An Unexpected Complication During Laparoscopic Herniorrhaphy. 1999;89(6):1576.

Rosati R, Bona S, Fumagalli U, Chella B, Peracchia AJSe. Laparoscopic treatment of paraesophageal and large mixed hiatal hernias. 1996;10(4):429-31.

Del Pizzo JJ, Jacobs SC, Bishoff JT, Kavoussi LR, Jarrett TWJTJou. Pleural injury during laparoscopic renal surgery: early recognition and management. 2003;169(1):41-4.