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CASE REPORT article

Front. Surg.

Sec. Visceral Surgery

This article is part of the Research TopicComplications in Major Abdominal Surgery: What to Expect and How to Deal with the Dark Side of SurgeryView all 5 articles

Unilateral Orbital Surgical Emphysema Following Laparoscopic Hiatal Hernia Repair and Nissen Fundoplication: A Case Report

Provisionally accepted
Ahmed M. SaggafAhmed M. Saggaf1Hassan U AlghamdiHassan U Alghamdi2Nasser A. AsiriNasser A. Asiri2Mihdhar O SaggafMihdhar O Saggaf1Ali A NagiAli A Nagi2Ranim M AlatatRanim M Alatat3Jumana TimrazJumana Timraz4Husna Irfan ThalibHusna Irfan Thalib4*
  • 1King Abdulaziz Hospital, Jeddah, Saudi Arabia
  • 2Prince Meshari Bin Saud General Hospital, Baha, Saudi Arabia
  • 3Ibn Sina National College for Medical Studies Medicine Program, Jeddah, Saudi Arabia
  • 4Batterjee Medical College, Jeddah, Saudi Arabia

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Word count: 139 Subcutaneous emphysema (SE) is a recognized but rare complication of laparoscopic surgery, and orbital involvement is particularly unusual. This report highlights a rare case of unilateral orbital SE following laparoscopic hiatal hernia repair with Nissen fundoplication. A 49-year-old hypertensive female with GERD underwent elective laparoscopic hiatal hernia repair. Intraoperatively, she developed sudden-onset left orbital emphysema. Imaging revealed mild left pneumothorax and bilateral pleural effusions. Conservative management led to complete resolution within 48 hours without visual impairment. Orbital SE following laparoscopy is uncommon but clinically significant. Risk factors include high insufflation pressure, previous abdominal surgeries, and prolonged operative time. Prompt clinical and radiological assessment ensures early diagnosis and prevents complications like orbital compartment syndrome. Surgeons must be vigilant of rare SE presentations post-laparoscopy. Conservative management is effective in mild cases, but early multidisciplinary intervention is essential to prevent vision loss.

Keywords: laparoscopic surgery, nissen fundoplication, orbital emphysema, Postoperative complication, Subcutaneous Emphysema

Received: 10 Nov 2025; Accepted: 02 Feb 2026.

Copyright: © 2026 Saggaf, Alghamdi, Asiri, Saggaf, Nagi, Alatat, Timraz and Irfan Thalib. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Husna Irfan Thalib

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Supplementary Material