Cardiac Tamponade as a Life-Threatening Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks

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dc.contributor.authorYerdel, Mehmet Ali
dc.contributor.authorSen, Ozan
dc.contributor.authorZor, Utku
dc.contributor.authorKara, Simay
dc.contributor.authorAcunas, Bulent
dc.date.accessioned2023-02-21T12:35:10Z
dc.date.available2023-02-21T12:35:10Z
dc.date.issued2018-01-01
dc.description.abstractBackground: Cardiac tamponade (CT) is a dreadful complication of laparoscopic antireflux surgery (LARS) with unknown incidence, and preventive measures are yet to be defined. Incidence during LARS with respect to usage/configuration of graft deployment is analyzed. Three-dimensional (3D) analysis of tack distribution provided anatomical insight to prevent cardiac injury. Materials and Methods: Data regarding the usage and configuration of graft deployment are retrieved from the prospective database. Grafting was posterior or posterior + anterior. Incidence of CT in all hiatoplasties is calculated. Tomography is reconstructed in 3D, showing the spatial distribution of the tacks. Tacks are numbered in the surgical video. Corresponding numbering is applied to the tacks in any particular tomography slice, utilizing the 3D images as an interface. A numbering-blinded radiologist is asked to identify the offending and the nonoffending tacks as the cause of tamponade. Tack-to-pericardium distances are recorded. Tacks having no measurable distance from the pericardium are regarded as offensive. Results: One CT occurred in 1302 consecutive LARS (0.076\%). The incidence is 0\% when no (379) or posterior (880) graft is used as opposed to 2.3\% rate in posterior + anterior (43) grafting. The distribution of offensive, nonoffensive but nearest, and safe tacks followed a pattern. All offensive tacks belonged to the anterior graft fixation, which we referred as the critical zone. Conclusion: CT during LARS is rare, and associated with graft fixation anterior to the hiatal opening. Avoiding graft fixation to the critical zone may prevent cardiac injury.
dc.description.issue9
dc.description.issueSEP
dc.description.pages1041-1046
dc.description.volume28
dc.identifier.doi10.1089/lap.2017.0713
dc.identifier.urihttps://hdl.handle.net/11443/1884
dc.identifier.urihttp://dx.doi.org/10.1089/lap.2017.0713
dc.identifier.wosWOS:000426522900001
dc.publisherMARY ANN LIEBERT, INC
dc.relation.ispartofJOURNAL OF LAPAROENDOSCOPIC \& ADVANCED SURGICAL TECHNIQUES
dc.subjectcardiac tamponade
dc.subjectlaparoscopic antireflux surgery
dc.subjecthelical tack
dc.subjectcomplication
dc.titleCardiac Tamponade as a Life-Threatening Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks
dc.typeArticle
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