A 74-year-old woman presented with a request for a second antireflux surgery seven years after the primary surgery. Because of the previous surgical intervention, an upper median laparotomy was used. Mesh-reinforced hiatoplasty with anterior fundophrenicopexy was performed as an antireflux procedure. A 6 × 6 cm prolene mesh was applied and fixed to the diaphragm with 10 helical staples. A few hours postoperatively, a decrease in blood pressure occurred and the subsequent computed tomography (CT) scan confirmed suspected cardiac tamponade. An emergency relaparotomy with pericardial fenestration was performed. Venous bleeding from the myocardium of the right ventricle, probably caused by a fundophrenicopexy suture, was stopped by resuturing, the pericardium was left open, and the left hemithorax was drained. The patient could be discharged on postoperative day 24.
A 62-year-old woman with gastroesophageal reflux disease and a large hiatal hernia underwent Nissen fundoplication with mesh hiatoplasty using absorbable tacks. On postoperative day 5, the patient developed acute respiratory distress syndrome with hypotension and oliguria. A thoracic CT scan showed a bilateral pleural effusion and a large pericardial effusion that caused the collapse of the right atrium and ventricle. She was taken back to the operating room for urgent surgical pericardial drainage. After that, the postoperative course was uneventful.