Gen Sx help: COPD and hiatal hernia repair

[mulberry]

On my surgery core and the attending asked about this and the possible complications that may arise. There isn't much information on this particular topic in uptodate. I understand COPD pts have hyper-inflated lungs that can push into the diaphragm, possibly causing weakness to the muscle over time. If the hiatus is large enough before repair, plus an already displaced/weakened diaphragm, could the surgery further damage the diaphragm? Am I missing something too simple here?

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[Psai]

Laparoscopy involves co2 insufflation. Can have a co2 embolus. Or just hypercarbia, especially if you're in reverse trendelenberg. Pat likely has gerd with high aspiration risk. Possible pneumothorax.