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.
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.