Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy. Report of two cases.

Two patients developed subcutaneous emphysema and pneumomediastinum during laparoscopic vagotomy. One of the patients also had a pneumothorax which produced a sudden increase in end-tidal carbon dioxide concentration preceding arterial oxygen desaturation. The pneumothorax was drained with an intercostal cannula. The patient required a twofold increase in minute ventilation to maintain normocarbia, probably because of the additional absorption of carbon dioxide through the pleural cavity. Despite the presence of a peritoneo-pleural communication, surgery was successfully completed. We believe that gas under tension in the peritoneal cavity dissected along tissue planes around the oesophagus opened up during surgery. Thus pneumomediastinum, subcutaneous emphysema and pneumothorax are definite risks associated with this new procedure.