• Cardiac imaging
• Cardiovascular disease
• Infections
• Inflammations
• Pericardial effusion
• Pericarditis

• Humans
• Pericardial Effusion/epidemiology
• Pericardial Effusion/etiology
• Pericardial Effusion/therapy
• Pericardial Effusion/diagnosis
• Incidence
• Pericardiocentesis
• Cardiac Tamponade/etiology

• cardiac tamponade
• iatrogenic
• malpractice
• medicolegal
• surgical errors

Giant hiatal hernias still pose a major challenge to digestive surgeons, and their repair is sometimes a highly complex task. This is usually performed by laparoscopy, while the role of the thoracoscopic approach has yet to be clearly defined.

To preoperatively detect patients with a giant hiatal hernia in whom it would not be safe to perform laparoscopic surgery and who, therefore, would be candidates for a thoracoscopic approach.

In the present study, using imaging test we preoperatively simulate the field of vision of the camera and the working area (instrumental access) that can be obtained in each patient when the laparoscopic approach is used.

From data obtained, we can calculate the access angles that will be obtained in a preoperative computerised axial tomography coronal section, according to the location of the trocar. We also provide the formula for performing the angle calculations If the trocars are placed in loss common situations, thus enabling us to determine the visibility and manoeuvrability for any position of the trocars.

The working area determines the cases in which we can operate safely and those in which certain areas of the hernia cannot be accessed, which is when the thoracoscopic approach would be safer.

• Hiatal hernia
• Angles
• Approach
• Laparoscopy
• Thoracoscopy

• Covered stent
• endovascular revascularization
• pericardial tamponade
• sharp recanalization
• superior vena cava occlusion

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.

• cardiac tamponade
• hiatal hernia
• surgical fixation devices
• surgical mesh

• Hiatal hernia
• Hiatal hernia/Surgery
• Surgical mesh