Soft-tissue images. Trocar-site hernia after laparoscopic procedures.
Bibliographic record
Abstract
54-year-old woman was admitted for elective laparoscopic repair of a recurrent ventral hernia. She had undergone open cholecystectomy and gastric bypass for obesity in 1990. Three years later a ventral hernia developed. This was repaired with mesh. When the hernia recurred, she was referred for laparoscopic repair. Once the hernia was reduced, polypropylene mesh was placed intraperitoneally and extracorporeally sutured with nonabsorbable suture material to the surrounding fascia. Fascia was reapproximated at the trocar sites. The patient was discharged 2 days later. Three days after discharge, the patient was readmitted, complaining of nausea, cramping abdominal pain and constipation. Clinical examination and radiography were consistent with a partial small-bowel obstruction (SBO). She was treated conservatively with nasogastric suction and intravenous administration of fluids. Over the next 72 hours her symptoms partially improved but did not resolve. Computed tomography of the abdomen and small-bowel followthrough (SBFT) contrast study were done. The SBFT showed a fixed defect, consistent with a Richter’s hernia of the mid-small bowel in the left upper quadrant (Fig. 1). Computed tomography revealed a softtissue density protruding outside the fascia in the left upper quadrant (Fig. 2), confirming the diagnosis. Laparoscopy demonstrated the Richter’s hernia through a previous trocar site (Fig. 3). The hernia was explored locally and viable small bowel reduced (Fig. 4). The fascial defect was repaired primarily. The patient made a smooth recovery and was discharged 4 days postoperatively. This case illustrates a rare complication of laparoscopic surgery as well as key points in managing these patients. Herniation through a trocar site occurs in 0.2% to 1.0% of laparoscopic surgical procedures 1 and can result in significant morbidity. All trocar sites larger than 5 mm diameter should have the fascia reapproximated to minimize hernia formation. This may be more difficult in obese patients because visualization of fascia may be suboptimal. Accurate approximation should be accomplished by endoscopic placement of fascial sutures under direct vision. Patients who undergo laparoscopic surgery usually have a short uncomplicated postoperative course. Any deviation from this requires aggressive investigation and treatment. Recently, Velasco and colleagues 2 stated that SBO within 2 weeks of a laparoscopic pro
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.035 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".