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 61-year-old female with a history of gastroesophageal reflux disease and hiatal hernia developed hemopericardium and tamponade one day after laparoscopic hiatal hernia repair and Toupet fundoplication. The patient underwent emergency pericardiocentesis and subsequent surgical pericardial window. During surgery, a tack that had been used to secure the mesh to the inferior aspect of the diaphragm was found to have penetrated the pericardium near the right ventricle. The patient recovered without further complications.