A 62-year-old woman with gastroesophageal reflux disease and a large hiatal hernia underwent Nissen fundoplication with mesh hiatoplasty using absorbable tacks. On postoperative day 5, the patient developed acute respiratory distress syndrome with hypotension and oliguria. A thoracic CT scan showed a bilateral pleural effusion and a large pericardial effusion that caused the collapse of the right atrium and ventricle. She was taken back to the operating room for urgent surgical pericardial drainage. After that, the postoperative course was uneventful.
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.