When CO2 goes wild – a tale of surgical emphysema, pneumothorax and a gas-filled adventure in laparoscopic hernia repair

Abstract

This case report describes a 69-year-old male patient who underwent laparoscopic inguinal hernia repair using a total extraperitoneal approach. Complications during the procedure were hypercarbia, surgical emphysema, and pneumothorax. Immediate interventions were necessary to address the rising end-tidal CO₂ levels, hypercarbia, and acidosis. The incidence of these complications may be higher than previously reported, particularly in extraperitoneal laparoscopic procedures, underscoring the importance of increased awareness among anaesthesiologists. This case report emphasises the significance of monitoring CO₂ inflation pressure, assessing subcutaneous CO₂ accumulation, and adjusting ventilation to enhance patient safety and promote the reporting of such complications in the future.