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 46-year-old man with gastroesophageal reflux disease underwent Nissen fundoplication with hiatal mesh reinforcement using absorbable tacks. Forty-eight hours after surgery, the patient developed hypotension and sweating. Cardiac magnetic resonance imaging showed a large pericardial effusion. Pericardiocentesis was performed with removal of 650 cc of bloody fluid. The pericardial drain could be removed two days later. The patient’s further course was uneventful.