Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience

AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01). No mortality was registered. More vascular lesions were found in group B. CONCLUSION: The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.

Secondary aortoduodenal fistula

Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.

Assessing tree crown fire damage integrating linear spectral mixture analysis and supervised machine learning on Sentinel-2 imagery

Crown fire damage is a mixture of three principal fire-related components:charred material,scorched foliage,and unaltered green canopy.This study estimated the abundance of these physical alterations in two immediate post-fire Mediterranean forest contexts(Portugal and Italy)by applying linear spectral mixture analysis(LSMA)on Sentinel-2 imagery.The tree crowns fire damage was subsequently mapped,integrating fractional abundance information in a random forest(RF)algorithm,comparing the accuracy resulting from the adoption of generic or image spectral libraries as the primary investigative goal.Although image-derived endmembers resulted in more effectiveness in terms of fire-related components abundance quantification(LMSAderived RMSE<0.1),the F-scores always were≥90%whether generic endmembers or image endmembers derived information was employed.The environmental heterogeneity of the two study areas affected the fire severity gradients,with a prevalence of the charred(PT)(45–46%)and green class(IT)(44–53%).Post-fire temporal monitoring was initialized by applying the proposed strategies,and the preliminary results showed a positive recovery trend in forest vegetation from the first year following the fire event,with a reduced charcoal predominance and an increasing proportion of green components.