Benchmarking global fisheries discards.

Discarding by fisheries is one of the most wasteful human marine activities, yet we have few estimates of its scale. Reliable estimates of global discards are essential for sustainable fisheries management. Using United Nations Food and Agriculture Organization databases on country-specific landings, we estimated the discard rate and magnitude for global marine and estuarine capture fisheries using fishery-specific discard rates derived from direct observations and global gear-specific discard rates estimated within a Bayesian modelling framework. An estimated 9.1 million tonnes are discarded annually (95% uncertainty interval: 7-16 M t)-or 10.8% of the global catch (95% UI: 10-12%). Encouragingly, this is about half of the annual global discard rate estimated in the late 1980s. Trawl fisheries, especially demersal otter trawls, warrant intensified efforts to reduce discards. Periodic benchmarks of global discards are needed to assess the performance of reduction efforts.

Not the usual suspects: human wound myiasis by phorids.

Infestation of animal tissues by dipteran larvae (myiasis) commonly occurs in many species, but it is unusual for humans in temperate regions. Nevertheless, human myiasis is regularly observed in many primary care facilities in the United States. Beyond medical issues associated with treating human myiasis, both the causal agent and the longevity of myiasis can have legal implications, for example, as evidence of neglect. Cases of human myiasis in the United States typically involve imported myiasis from torsalo, Dermatobia hominis (Linnaeus, Jr.) (Diptera: Oestridae), or facultative myiasis from calliphorids. Here, however, we report two cases of wound myiasis caused by phorid larvae occurred in southeastern Nebraska within 10 mo. Degree-day analysis indicates initial infestation occurred 2 and 3 d before discovery. There are few previous reports of phorid wound myiasis; so, the occurrence of two cases in so short a period suggests that phorids are more important than previously appreciated.

Variation in fundic dimensions with respect to short gastric vessel division in laparoscopic fundoplication.

BACKGROUND: This study analyzes the geometry involved in laparoscopic fundoplication with respect to short gastric vessel division for the creation of a tension-free Nissen fundoplication. METHODS: For fundoplication, the gastric fundus must be long enough to traverse the fixed distance between the right edge of the plication and the highest lateral fixation of the fundus (distance alpha) and to encircle the esophagus (esophageal circumference). We compared these two dimensions to the length of fundus available for fundoplication both before and, when needed, after division of the short gastric vessels. RESULTS: For tension-free Nissen fundoplication, the available fundic length must exceed the sum of the esophageal circumference and the distance alpha. In some patients, exceeding this sum requires division of the short gastric vessels, thereby increasing fundic length. Short gastric vessel division is not necessary in all patients due to significant individual variations in fundic length. CONCLUSION: There are significant individual variations in fundic length available for fundoplication. The length of the fundus can be increased by dividing short gastric vessels, but it is not always necessary. It is, however, important to take this parameter into consideration when performing the operation in order to avoid postoperative dysphagia.

Small bowel obstruction secondary to stapled laparoscopically assisted vaginal hysterectomy.

BACKGROUND: This study analyzes the complication of small bowel obstruction following stapled division of the adnexa during laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: We reviewed the records of three patients with small bowel obstruction following stapled LAVH. We then tested the proposed mechanisms of obstruction by firing endoscopic staplers across silicon tubing to simulate division of the adnexal structures. Staple shape, spillage, and closure were analyzed. RESULTS: Small bowel obstruction can result when a partially formed endoscopic staple hooks the small bowel. The problem can be traced to either spilled intraperitoneal staples or partially formed staples that adhere to part of the adnexal staple line. The mechanisms staple closure, spillage, and ability to hook small bowel were confirmed with a laboratory model. CONCLUSIONS: Techniques for reducing the incidence of small bowel obstruction following stapled LAVH include minimizing staple spillage and careful inspection of the adnexal staple line for partially formed staples.

Short-term outcome of laparoscopic paraesophageal hernia repair. A case series of 58 consecutive patients.

BACKGROUND: The purpose of this study is to determine the morbidity, mortality, and short-term outcomes associated with laparoscopic paraesophageal hernia repair (LPHR). METHODS: A series of 58 consecutive LPHRs performed by the author were reviewed with an average 1-year follow-up. Morbidity and mortality rates were compared with historical series of open repairs. Anatomy and technical considerations pertinent to LPHR were reviewed. RESULTS: There were no procedure-related or perioperative deaths in this series of patients undergoing LPHR. Four major complications occurred (7%), two of which required reoperation, all in urgently repaired patients. One patient required conversion to laparotomy (1. 7%). Based on symptoms, there were no reherniations. No patients had long-term dysphagia worse than preoperatively. Preoperative symptoms of chest pain, esophageal obstruction, hemorrhage, and reflux were resolved in all patients. CONCLUSIONS: LPHR is safe, effective, and compares favorably to historical series of open paraesophageal hernia repair.

Laparoscopic hypothermia: heat loss from insufflation gas flow.

To determine the effects of laparoscopic gas flow on intraoperative hypothermia, we measured heat loss from intra-abdominally heating cold insufflation gas and intra-abdominal evaporative heat losses. Heat loss from heating insufflated CO2 was 304 L/Cal; evaporative loss was 109 L/Cal. Even in the worst hypothetical case of complete water saturation of dry insufflated gas, total heat loss would total 81 L/Cal, a relatively minor contribution to surgical hypothermia.

Laparoscopic transabdominal preperitoneal repair of a hernia of Morgagni.

A hernia of Morgagni was successfully repaired laparoscopically by reducing the hernia, mobilizing the peritoneum around the perimeter of the defect, and stapling polypropylene mesh onto the surrounding fascia. This type of repair is technically easy and should give a high probability of success.

Retained staples as a cause of mechanical small-bowel obstruction.

The use of mechanical stapling devices in endoscopic surgery has become widespread and commonplace. Although problems have been identified with these, to our knowledge no description has been made of retained, free intraperitoneal staples causing significant morbidity. We describe the case of a patient who underwent laparoscopically assisted vaginal hysterectomy. Four weeks postoperatively she developed a mechanical small-bowel obstruction which was caused by a free intraperitoneal staple creating an obstructing band. The obstruction was relieved laparoscopically. We believe that while retained free intraperitoneal staples are generally of no clinical consequence, surgeons should be aware that the potential exists for significant morbidity.