A 57-year-old woman presented with right, medial, and left congenital diaphragmatic hernia defect. The hernia defect was closed laparoscopically by a running suture and then a mesh placed as an onlay fixed with helical hernia tacks. The patient developed cardiac tamponade on the second day due to tack-induced bleeding of an epicardial artery of the inferior surface of the heart, which required emergency pericardial drainage. The outcome was good, and discharge home was allowed after 1 month.
An 82-year-old man presented with an 8-cm mixed hiatal hernia with grade IV esophagitis. Surgical treatment consisted of laparoscopically mesh-augmented hiatoplasty with anterior fundophrenicopexy. Because of accidental rupture of the right crus of the diaphragm, a 15 × 15 cm prolene mesh was necessary to reconstruct the hiatus. The mesh was fixed by 16 helical tacks. During the first 24 postoperative hours, deteriorating oxygen saturation with increasing dyspnea was most notable. After 48 h, the patient experienced severe retrosternal pressure with simultaneous tachyarrhythmia and consecutive circulatory failure. The patient died despite resuscitation attempts. The autopsy revealed cardiac tamponade originating from an epicardial vascular erosion caused by one of the helical tacks.