An 82-year-old man presented with an 8-cm mixed hiatal hernia with grade IV esophagitis. Surgical treatment consisted of laparoscopically mesh-augmented hiatoplasty with anterior fundophrenicopexy. Because of accidental rupture of the right crus of the diaphragm, a 15 × 15 cm prolene mesh was necessary to reconstruct the hiatus. The mesh was fixed by 16 helical tacks. During the first 24 postoperative hours, deteriorating oxygen saturation with increasing dyspnea was most notable. After 48 h, the patient experienced severe retrosternal pressure with simultaneous tachyarrhythmia and consecutive circulatory failure. The patient died despite resuscitation attempts. The autopsy revealed cardiac tamponade originating from an epicardial vascular erosion caused by one of the helical tacks.
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.