Persistent bilateral pneumothorax after robotic-assisted inguinal hernia repair: possible relevance to recent esophageal cancer surgery - a case report

JA Clin Rep. 2023 Jun 22;9(1):37. doi: 10.1186/s40981-023-00630-y.

Abstract

Background: Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. There has been no report describing pneumothorax that persisted for a week or more after laparoscopic surgery. Herein, we report a case of bilateral pneumothorax after laparoscopic surgery, which appears to have occurred by a different mechanism than previously described.

Case presentation: A 65-year-old male, with a past history of esophagectomy and retrosternal gastric tube reconstruction 4 months earlier, underwent a robotic-assisted inguinal hernia repair. Postoperative chest x-rays revealed the development of bilateral pneumothorax, which became worse on postoperative day (POD) 1 and took more than 9 days to resolve spontaneously. We assumed that intra-abdominal gas replaced by the air after pneumoperitoneum might have migrated into thoracic cavities through an opened esophageal hiatus or along the retrosternal route.

Conclusions: Laparoscopic surgery after radical esophagectomy may be associated with an increased risk of postoperative pneumothorax.

Keywords: Case report; Esophagectomy; Pneumothorax; Postoperative complication; Robot-assisted inguinal hernia surgery.