Cardiac tamponade after laparoscopic hiatal herniorrhaphy: a rare but preventable iatrogenic complication

Iatrogenic cardiac tamponade is a life-threatening complication in both cardiac and non-cardiac surgeries, with a notable risk during laparoscopic hiatal herniorrhaphy due to the diaphragm's proximity to the pericardium. We report the case of a 71-year-old woman who presented with cardiovascular instability 48 h after hernia repair. Imaging showed pneumomediastinum and a large pericardial effusion causing tamponade, which was initially managed with pericardiocentesis. Recurrent instability from a massive hemothorax required emergency thoracotomy, which revealed a pericardial perforation from a surgical tacker. The patient recovered following surgical repair and was discharged. This case emphasizes that cardiac tamponade should be a key differential diagnosis in post-hiatal herniorrhaphy patients with hemodynamic compromise. Careful surgical technique, particularly avoiding tackers on the diaphragm, and a high level of suspicion are essential for preventing and managing this severe complication.