Vidrio Duarte Ramon, Vidrio Duarte Eduardo, Gutierrez Ochoa Juan, Ortega León Luis H, Solis Rojas Carolina
Surgery, Hospital General de Mexico, Mexico City, MEX.
General Surgery, Hospital Angeles Metropolitano, Mexico City, MEX.
Cureus. 2020 Jun 2;12(6):e8416. doi: 10.7759/cureus.8416.
Since the first successful use of mesh in hernia surgery, the development and progress in materials, techniques, and procedures have increased exponentially; consequently, surgeons started to use meshes for hiatal hernia repair to prevent postoperative hernia recurrences and complications. Nonetheless, there are alarming reports in literature concerning cardiac tamponade as an apparently rare complication of hiatal mesh placement, especially when fixation is performed with tacks. A 50-year-old female diagnosed with gastroesophageal reflux disease undergoes an elective laparoscopic Nissen fundoplication and hiatal hernia repair with tack fixation of the mesh; on the fourth postoperative day she was readmitted with cardiac tamponade diagnosed via echocardiography, and CT scan showed proximity of the tacks to the pericardium. She underwent a failed attempt of ultrasound guided pericardiocentesis (PC), therefore, a pericardial window was performed. The ideal method for diaphragmatic mesh fixation is still controversial. Some recent articles alert of this potential risk; although the manufacturers contraindicate the use of tacks in the diaphragm, one-third of surgeons prefer this method.
自从首次成功地在疝修补手术中使用补片以来，材料、技术和手术方法的发展与进步呈指数级增长；因此，外科医生开始使用补片进行食管裂孔疝修补，以防止术后疝复发和并发症。尽管如此，文献中有令人担忧的报道称，心脏压塞是食管裂孔补片置入术一种明显罕见的并发症，尤其是在用钉固定时。一名50岁诊断为胃食管反流病的女性接受了择期腹腔镜Nissen胃底折叠术和食管裂孔疝修补术，补片用钉固定；术后第四天，她因心脏压塞再次入院，经超声心动图诊断，CT扫描显示钉靠近心包。她接受超声引导下心包穿刺术（PC）失败，因此进行了心包开窗术。膈肌补片固定的理想方法仍存在争议。最近的一些文章提醒了这种潜在风险；尽管制造商禁止在膈肌中使用钉，但三分之一的外科医生更喜欢这种方法。
