Subcutaneous emphysema during extended totally extraperitoneal inguinal hernia repair: A case report

Abstract

Laparoscopic inguinal hernia repair is increasingly performed because of reduced postoperative pain and faster recovery compared with open surgery. However, carbon dioxide (CO ₂ ) insufflation may lead to specific complications, including subcutaneous emphysema (SE). A 65-year-old man underwent elective totally extraperitoneal extended view repair for right inguinal hernia. Fifty minutes after CO ₂ insufflation, a progressive rise in end-tidal CO ₂ reaching 60 mmHg was observed, accompanied by mild oxygen desaturation. Physical examination revealed subcutaneous crepitus extending to the patient’s neck. Ventilatory adjustments were performed, and the insufflation pressure was reduced. Subcutaneous catheters were inserted into the supraclavicular region. The procedure was successfully completed. Postoperative chest radiography confirmed extensive SE without pneumothorax or pneumomediastinum. The patient remained clinically stable and was conservatively managed. Complete resolution was confirmed radiologically, and the patient was discharged on the third postoperative day. SE is an uncommon but increasingly recognized complication of extraperitoneal laparoscopic hernia repair. Vigilant intraoperative monitoring allows for early detection and appropriate management, preventing unnecessary morbidity.