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.
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.