title: Cardiac complications after laparoscopic large hiatal hernia repair. Is it related with staple fixation of the mesh? -Report of three cases.
abstract: BACKGROUND
  Laparoscopic Nissen operation with mesh reinforcement remains being the most popular operation for large hiatal hernia repair. Complications related to mesh placement have been widely described. Cardiac complications are rare, but have a fatal outcome if they are misdiagnosed.
  
  
  METHODS
  We sought to outline our institutional experience of three patients who developed cardiac complications following a laparoscopic Nissen operation for large hiatal hernia repair.
  
  
  CONCLUSIONS
  Laparoscopic hiatoplasty and Nissen fundoplication are safe and effective procedures for the hiatal hernia repair, but they are not exempt from complications. Fixation technique and material used must be taken into account. We have conducted a review of the literature on complications related to these procedures.
  
  
  CONCLUSIONS
  In the differential diagnosis of hemodynamic instability after laparoscopic hiatal hernia repair, cardiac tamponade and other cardiac complications should be considered.
authors.affiliation: Department of Surgery Clinic University Hospital, Valencia, Spain.
authors.forename: Maria Del Carmen
authors.initials: Mdel C
authors.lastname: Fernandez
authors.affiliation: Department of Surgery Clinic University Hospital, Valencia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Diaz
authors.affiliation: Department of Surgery Clinic University Hospital, Valencia, Spain ; Department of Surgery, University of Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: López
authors.affiliation: Department of Surgery Clinic University Hospital, Valencia, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Martí-Obiol
authors.affiliation: Department of Surgery Clinic University Hospital, Valencia, Spain ; Department of Surgery, University of Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ortega
keywords: Cardiac complications; Cardiac tamponade; Giant hiatal hernia; Mesh fixation; Mesh hiatoplasty