An 84-year-old woman suffered from a type IV diaphragmatic hernia with a tortuous intrathoracic stomach and grade II esophagitis. The stomach was reduced into the abdominal cavity and the hernia sac resected. A coated polyester mesh was attached to the crura with 5-mm titanium helical tacks. After an uneventful recovery, the patient suddenly developed cardiogenic shock on postoperative day 14. A left thoracotomy was subsequently performed. There was active bleeding of the epicardium from a number of pointed lesions, just opposite the tackers which had penetrated the pericardium. The offending tacks were removed and the defects in the epicardium sutured. The patient was discharged 18 days after thoracotomy.
A 79-year-old woman underwent laparoscopic hiatal hernia repair with mesh implantation. Tacks were used to secure the mesh to the diaphragm. Nine hours after surgery the patient died from circulatory collapse. Autopsy showed perforation of the pericardium and the right coronary artery by a tacker.