This chapter discusses the rarity of catastrophic complications following antireflux and hiatal hernia surgeries, citing an analysis of 5502 cases showing a low overall prevalence of life-threatening events. However, it emphasises the potential underreporting of such complications. A case study highlights a post-Nissen herniation leading to a perforated stomach, requiring emergency laparotomy and subsequent reconstruction. The case underscores the importance of prompt diagnosis through CT imaging in suspected complications, advocating for early surgical intervention to prevent necrosis and perforation. It also stresses careful chest drain placement to avoid gastric injury and the challenges of reduction of the distended stomach. This comprehensive overview provides vital insights into managing rare yet critical complications of antireflux surgeries, emphasising timely intervention to avoid the development of gastric ischaemia necessitating resection.