Cardiac tamponade is a rare complication of diaphragmatic hernia repair. We report a case of a 79-year-old female, who underwent a laparoscopic procedure with mesh implantation. Tackers were used to secure the mesh to the diaphragm. Nine hours after surgery the patient died from circulatory collapse. Autopsy showed perforation of the pericardium and the right coronary artery by a tacker. A review of the literature reveals nine earlier reported cases. In three of these cases the complication resulted in death. Rapid diagnosis and intervention can decrease mortality. To avoid further incidents it is necessary to consider alternatives to tacks.