Cardiac tamponade as a life-threatening complication in hernia repair

Background. The placement of mesh in the repair of all types of hernia has been reported to decrease recurrence rates. There are several well known complications related to mesh repairs, including infection, erosion, seroma, and pain. Lesser reported are cardiac injuries secondary to anchoring of the mesh to the diaphragm. Methods. We report 2 previously unreported, unpublished cases of cardiac tamponade after mesh fixation to the diaphragm and present a review of the literature and search of the US Food and Drug Administration's Manufacturer and User Device Experience (MAUDE) database. Results. We reviewed a total of 10 cases of cardiac tamponade in hiatal hernia repair, 6 resulting in patient mortality, 5 cases in ventral hernia repair, 4 being fatal. Ten cases were caused by the helical tacker, 2 by sutures, I by the straight stapler, and in 1 case the cause was not identified. Conclusion. When anchoring mesh to the diaphragm, it is necessary to consider the risk of injury to the heart and cardiac tamponade, especially if the helical tacker is used in this region. Only with appropriate awareness and recognition can this catastrophic complication be avoided. (Surgery 2012;152:133-5.)