Subcutaneous Emphysema in Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia: A Rare Case Report

Abstract

Surgeries for inguinal hernias are among the most commonly performed procedures worldwide. Compared to traditional open surgery for inguinal hernias, there has been a rise in the use of Total Extraperitoneal (TEP) repair. TEP has been recommended as a safe method for the repair of inguinal hernias. The present report describes a case of subcutaneous emphysema, a rare complication observed after TEP. Subcutaneous emphysema is defined as the de novo creation or infiltration of air in the skin’s subcutaneous layer, which includes the epidermis and dermis. It can occur in various body parts. Factors contributing to the development of subcutaneous emphysema include total gas volume, gas flow rate, the use of a valveless trocar system and robotic fulcrum force. A 56-year-old male was planned for elective TEP surgery. Intraoperatively, the patient experienced a rise in End-tidal Carbon Dioxide (EtCO2), which was followed by an examination that revealed subcutaneous emphysema extending up to the neck. Immediate measures were taken, including increasing the Fraction of Inspired Oxygen (FiO2) to 100% and making nicks on the anterior chest wall and supraclavicular region. A repeat chest X-ray showed no recurrence of subcutaneous emphysema and the patient was discharged seven days postoperatively. Although subcutaneous emphysema is a rare condition, it can lead to life-threatening complications, such as pneumothorax. Therefore, early diagnosis and prompt treatment are essential.

Keywords

• end-tidal carbon dioxide
• fraction of inspired oxygen
• laparoscopy
• pneumomediastinum
• pneumothorax