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.
A 70-year-old woman presented with a giant hiatal hernia with intrathoracic stomach. The patient underwent laparoscopic Nissen fundoplication with hiatal mesh reinforcement using absorbable tacks. On postoperative day 2, the patient developed hypotension, tachycardia, and irregular pulse.\nA CT scan revealed an extrapericardial hematoma in the hernia sac with mild left atrium compromise. Conservative treatment was decided and the patient discharged on postoperative day 15.