Introduction: Anti-reflux surgery becomes one of the most common laparoscopic procedures during the last decade, with perioperative morbidity rates up to 19% and mortality around 0.1%. The increasing usage of prosthetic mesh in large hiatal hernias led to a new type of complications such as mesh migration or infection, rejection and life-threatening cardiac tamponade. As of today, only few cases with cardiac tamponade after laparoscopic hiatal hernia repair are reported in the English literature. Here we present a case with cardiac tamponade after laparoscopic mesh-repair in order to increase the awareness of this rare complication.
Case Report: We present a 72-year-old female with a large symptomatic type II hiatal hernia and grade II reflux disease by Savary-Miler classification. Nissen’s fundoplication was performed along with relaxing incision of the left crus. Omiramesh® mesh was used and fixed with Secure strap® to the diaphragm. After six hours because of dyspnea, anxiety and retrosternal chest pain, desaturation, atrial fibrillation, significant pericardial effusion on echocardiography and hemodynamic instability she was consulted with thoracic surgeon and pericardial puncture with evacuation of 120 ml blood was performed. The patient was transferred immediately to the operative room for thoracotomy because of lack of effect, but she died before the thoracic procedure.
Conclusion: The early diagnosis and proper management are crucial in case of cardiac tamponade. Understanding the mechanism of cardiac tamponade and the proper fixation of prosthetic material only to the diaphragmatic crus is the way to avoid this complication. Using glue may be a safe alternative to staples.

Keywords: Cardiac tamponade, Hiatal hernia, Laparoscopic fundoplication, Mesh repair