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 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.