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Question 5#

While performing a laparoscopic Nissen fundoplication during the transhiatal dissection the mediastinal pleura is compromised and a CO2 pneumothorax develops. What is the initial preferred management of the pneumothorax?

a. Needle thoracostomy over the second intercostal space, mid-clavicular line
b. Enlargement of the defect and placement of an 18-French red rubber catheter across the defect
c. Abort the procedure and emergent tube thoracostomy with a 28-French chest tube
d. No intervention is needed. Continue with the planned procedure

Correct Answer is B


When a pneumothorax occurs with laparoscopic Nissen fundoplication or Heller myotomy, it is preferable to place an 18-French red rubber catheter with multiple holes cut out of the distal end across the defect. At the end of the procedure, the distal end of the tube is pulled out a 10-mm port side (as the port is removed), and the pneumothorax is evacuated to a primitive water-seal using a bowl of sterile water or saline.