Life-Threatening Cardiac Tamponade After Hiatal Hernia Surgery: A Review of Diagnostic Pitfalls and Therapeutic Interventions

Background: Previous studies have reported deaths due to undiagnosed cardiac tamponade following hiatal hernia surgery, with an alarmingly high associated mortality rate. This review aims to raise awareness and improve the diagnostic accuracy of cardiac tamponade among surgeons who perform hiatal hernia repair. Methods: A retrospective analysis was conducted on cases of cardiac tamponade following hiatal hernia repair. Data collected included patient age, surgical approach, mesh fixation method, timing of cardiac tamponade diagnosis, and treatment strategies. Results: A total of 23 eligible articles reporting on 30 patients with cardiac tamponade after hiatal hernia repair were included in this review. The age of patients ranged from 40 to 84 years, with a median age of 66 years. Tacker was used in 20 patients (66.7%) for mesh fixation. In half of the cases (50.0%), cardiac tamponade was diagnosed within 48 hours after surgery. Treatment mainly included pericardiocentesis and open drainage. Seven (23.3%) patients died postoperatively. Cardiac tamponade was undiagnosed in 4 patients (13.3%), all of whom died. Mortality rates were 100.0% in the undiagnosed group and 4.3% in the diagnosed group. Conclusions: Accurate diagnosis and prompt management are crucial for rescuing patients from life-threatening cardiac tamponade following hiatal hernia surgery.