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Background: Abdominal musculature injuries comprise the third most prevalent time-loss injury across professional baseball. Despite increased awareness and prevention attempts in the recent decade, the trends of these abdominal injury numbers in Major League Baseball (MLB) are not fully understood. Purposes: To update the trends in oblique and intercostal injuries, analyze the impact of these injuries based on time out of play, and identify factors that correlate with increased injury severity to help with recovery time prognostication for the sports medicine community. Study Design: Descriptive epidemiology study. Methods: Using the MLB Health and Injury Tracking System, the authors identified all abdominal and core musculature injuries that resulted in time out of play in MLB and Minor League Baseball (MiLB) between the 2011 and 2021 seasons. These were filtered for injuries that resulted in ≥1 days missed (DM) during spring training, the regular season, and postseason. A Student t test was utilized to assess for significant differences for all normally distributed values. Regression analysis was utilized for determining change over time. For all statistical comparisons, the threshold for alpha was set to P <.05. Results: During the study period between 2011 and 2021, there were 4560 total abdominal injuries among 3401 athletes. When filtered for in-season, time-loss injuries defined as spring training, regular season, and postseason, there were 2890 injuries. Of these, 1928 were oblique injuries, 453 were intercostal injuries, and 115 were rectus injuries. The number of oblique injuries each season increased for all of baseball (P <.001), as well as for MLB (P =.009) and MiLB (P =.012) individually. Of the 1928 oblique injuries, 498 (26%) oblique injuries occurred at the MLB level and 1430 (74%) occurred at the MiLB level. Batting and pitching-related injuries comprised 860 (45%) and 729 (38%) oblique injuries, with a total of 18,455 DM and 20,891 DM, respectively. This corresponded to a mean of 22 DM for batting injuries and 29 DM for pitching injuries (mean difference, 7.2; 95% CI, 5.27-9.13; P <.001). Conclusion: This decade-long study on professional baseball revealed a significant increase in abdominal oblique injuries across MLB and MiLB, with the largest number of injuries observed in the 2021 season. Meanwhile, there was a significant decrease in intercostal injuries across professional baseball during these years. Such injuries continue to pose challenges, leading to substantial DM per injury and affecting players from various positions. [ABSTRACT FROM AUTHOR]

Background: Oblique strains have become a common injury among professional baseball players. The influence of player workload on oblique strains remains unknown. Purpose/Hypothesis: To determine whether workload is a risk factor for oblique strains in professional baseball players. We hypothesized that fewer days of rest, more innings pitched/fielded per game, and more batters faced/plate appearances per game would significantly increase a player's risk of sustaining an oblique strain. Study Design: Case-control study; Level of evidence, 3. Methods: All professional baseball players who sustained an oblique strain between 2011 and 2017 were identified using the Major League Baseball Health and Injury Tracking System. A separate dataset of player usage—days of rest per game, innings pitched or fielded per game, and batters faced or plate appearances per game—was used to determine the workload. We compared these usage variables between player games ≤2, ≤6, ≤12, and >12 weeks before a documented oblique strain with player games from a control group of players with no oblique strains. In a paired analysis, we compared acute (player games ≤2, ≤6, and ≤12 weeks preinjury) versus chronic (player games >12 weeks preinjury) workloads. Results: There were 311 oblique strains in pitchers and 392 oblique strains in position players during the study period. In pitchers, more innings pitched and more batters faced were associated with a subsequent oblique strain (P <.001 for all). In position players, fewer days of rest, more innings fielded, and more plate appearances were associated with a subsequent oblique strain (P <.001 for all). Pitchers who pitched ≥7 innings per game had a 2.4-fold (95% CI, 1.4-4.9) increased risk of subsequent oblique strain compared with those who pitched 1 inning per game. The percentage of position players with a subsequent oblique strain increased by 2.1-fold (95% CI, 1.3-3.5) with >4 plate appearances compared with 1 plate appearance per game. Conclusion: Our analysis demonstrated that workload was associated with an increased risk of sustaining an oblique injury in professional baseball players. High workload over time was more predictive of oblique strains compared to acute increases over chronic baseline workload. [ABSTRACT FROM AUTHOR]

Background: In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. Purpose: To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. Study Design: Case series; Level of evidence, 4. Methods: We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis–adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score–Sport (HOS–Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS–Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. Results: A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS–Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS–Sport score at follow-up or the successful return to preinjury sport. Conclusion: Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent. [ABSTRACT FROM AUTHOR]

Because of the COVID-19 pandemic, the National Football League (NFL) made changes to its operations for the 2020 season. We hypothesize an increase in the rate of injuries during the 2020 season. Publicly available data were reviewed to identify NFL injuries from the 2015-2020 seasons. Player position, description of injury, date of injury, and injury setting were recorded. p#0.05 was considered statistically significant. For the 2020 season, compared with the 2015-2019 seasons, there was an increased risk of injury during the regular season overall relative risk (RR) 5 1.308 (p, 0.05), week (W)1 RR 5 7.33 (p, 0.05), W1-6 RR 5 1.964 (p, 0.05), W7-12 RR 5 1.8909 (p, 0.05), and during the postseason overall RR 5 1.1444 (p, 0.05), calculated using analysis of variance. There was an overall increased risk of abdominal or core injuries RR51.248 (p < 0.05), groin or hip injuries RR52.534 (p < 0.05), and hamstring injuries RR 5 3.644 (p, 0.05). There was an increased risk of hamstring injuries in cornerbacks RR 5 3.219 (p, 0.05) and running backs RR 5 1.1394 (p, 0.05), hip or groin injuries in guards RR 5 1.105 (p, 0.05), Achilles tendon injuries in safeties RR51.6976 (p < 0.05), quadriceps injuries in running backs RR51.6191 (p < 0.05), and arm injuries in defensive tackles RR 5 1.221 (p, 0.05). There was an increase in the overall rate of injuries in the 2020 NFL season, both in the regular season and postseason, compared with the 2015-2019 seasons. The overall rate of abdominal or core, groin or hip, and hamstring injuries increased. Specific player positions saw unique increases in rates of injuries. These findings may be due to numerous operational changes implemented, such as reduced in-person training and the elimination of the preseason, leading to suboptimal, sportsspecific conditioning and increased risk of musculoskeletal injury. [ABSTRACT FROM AUTHOR]

Introduction. One of the main interventions carried out by nursing professionals is the care of wounds. Its purpose is to avoid possible complications and stimulate the scarring of the wounded tissue. The objective of this investigation was to determine the nursing interventions carried out in patients with open abdomens and enterocutaneous fistulas via a literature review. Methodology. A narrative review was carried out over 10 months. The databases used were: PubMed, ScienceDirect, ClinicalKey, MEDLINE, SciELO, and Ovid. Fifty articles that met the objective of the review were used. Results. Nursing care related to basic and specific care in patients with open abdomens and enterocutaneous fistulas was found. Discussion. Different authors agree on the use of the Bogotá Bag, is one of the most used nursing interventions for open abdominal wounds, intraabdominal measurement, which allows for early identification of Abdominal Compartment Syndrome, and maintenance of nutritional objectives in patients with enterocutaneous fistulas allow for successful recovery. Conclusions. We could determine that there are different types of nursing care that must be considered in the handling of open abdomen and enterocutaneous fistulas. All these types of care allow for nursing staff to have a useful scientific support when providing care to patients with these health conditions. This is in order to avoid or reduce the risks of dehydration, hydroelectrolytic imbalance, malnutrition, sepsis, and even death. [ABSTRACT FROM AUTHOR]

Introduction Core muscle injuries (CMI) are common in every sport. To minimize lost playing time, providers apply various nonsurgical treatments, including platelet-rich plasma, corticosteroids, ultrasound (US)-guided percutaneous tenotomy, and prolotherapy. Limited data exist with regard to their effectiveness. We chose to review a cohort of consecutive professional and collegiate athletes who sustained CMI at various points within their seasons and underwent a combination of US-guided percutaneous needle "tenotomy" and corticosteroid injections to complete the remainder of their seasons. Methods Twenty-five consecutive collegiate or professional athletes with CMI involving the rectus abdominis–adductor aponeurotic plate were included in this retrospective study. Athletes with concomitant symptomatic hip femoroacetabular impingement were included in the study. The primary outcome measure was whether athletes completed their seasons. Secondary measures were weeks played after the procedures (delay until surgery), need for repeat procedures, and outcomes after eventual surgery. Postoperative performance was assessed via interviews at 6 wk and 6 months postoperatively. Results Twenty-one of 25 (84%) athletes completed their seasons. On average, athletes returned to play 3 d (range, 1–9 d) after the procedures. Surgical repair was delayed a mean of 18 wk (range, 2–44 wk). Seven athletes had concomitant symptomatic femoroacetabular impingement and six underwent combined hip arthroscopy and core muscle repairs. Among 17 patients who eventually had core muscle surgery alone (no hip surgery), 82% (14 of 17) reported performing at their preinjury level at 6 wk. At 6 months, 96% of postop athletes (22 of 23) reported performing at their preinjury level. Conclusions Temporizing CMI with US-guided percutaneous tenotomy and corticosteroid injections is effective in allowing continued sport participation among high-level athletes and does not negatively affect postoperative outcomes. [ABSTRACT FROM AUTHOR]

Side strains refer to injuries of the internal/external oblique or the transversus abdominis, commonly at their attachment to the lower four ribs and rarely at their pelvic attachments. Injuries at the rib attachments are well-described while literature on iliac crest attachment injuries is sparse. We report four cricketers who had side strain and direct impact injuries with varying degrees of severity at the iliac crest attachment. The purpose of this article is to describe the anatomy, possible mechanism of injury, and imaging findings in the lateral abdominal wall muscle injuries at the iliac crest, which have not been described previously. [ABSTRACT FROM AUTHOR]

Background: Closing the defect (CD) during laparoscopic ventral hernia repair began to be performed in order to decrease seroma, to improve the functionality of the abdominal wall, and to decrease the bulging effect. However, tension at the incision after CD in large defects is related to an increased rate of pain and recurrence. We present the preliminary results of a new technique for medium midline hernias as an alternative to conventional CD.Methods: A prospective controlled study was conducted from January 2015 to January 2017 to evaluate an elective new procedure (LIRA) performed on patients with midline ventral hernias (4-10 cm width). The posterior rectus aponeurosis was opened lengthwise around the hernia defect using a laparoscopic approach to create two flaps and was then sutured. The size of the flaps was estimated using a mathematical formula. An on-lay mesh was placed intraperitoneal overlapping the fascia defect. The data analyzed included patient demographics, operative parameters, and complications. A computerized tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma.Results: Twelve patients were included. Mean width of the defect was 5.5 cm. Average VAS (24 h) was 3.9, 1.1 (1 month), and 0 (1 year). Mean preoperative distance between rectus was 5.5 cm; postoperative was 2.2 cm (1 year). Radiological seroma at first month was detected in 50%. Mean follow-up was 15 months.Conclusion: The LIRA technique could be considered as an alternative to conventional CD or endoscopic component separation for medium defects under 10 cm in width. This technique obtained a "no tension" effect that could be related to a lower rate of postoperative pain with no recurrence or bulging, being a safe, feasible, and reproducible technique. [ABSTRACT FROM AUTHOR]

Background: A minority of patients undergoing posterior component separation (PCS) have abdominal wall defects that preclude complete reconstruction of the visceral sac with native tissue. The use of absorbable mesh bridges (AMB) to span such defects has not been established. We hypothesized that AMB use during posterior sheath closure of PCS is safe and provides favorable outcomes.Methods: We performed a retrospective review of consecutive patients undergoing PCS with AMB at two hernia centers. Main outcome measures included demographics, comorbidities, and post-operative complications.Results: 36 patients were identified. Post-operative wound complications included five surgical site infections. At a median of 27 months, there were five recurrent hernias (13.9%), 2 of which were parastomal, but no episodes of intestinal obstruction/fistula.Conclusions: Utilization of AMB for large posterior layer deficits results in acceptable rates of perioperative wound morbidity, effective PCS repairs, and does not increase intestinal morbidity or fistula formation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to induce both trunk extensor and abdominal muscle fatigue, on separate occasions, and compare their effects on standing postural control and trunk proprioception, as well as look at the effects of a recovery period on these outcome measures. A total of 20 individuals participated, with 10 (5 males and 5 females) completing either a standing postural control or lumbar axial repositioning protocol. Participants completed their randomly assigned protocol on two occasions, separated by at least 4  days, with either their trunk extensor or abdominal muscles being fatigued on either day. Postural control centre of pressure variables and trunk proprioception errors were compared pre- and post-fatigue. Results showed that both trunk extensor and abdominal muscle fatigue significantly degraded standing postural control immediately post-fatigue, with recovery occurring within 2 min post-fatigue. In general, these degradative effects on postural control appeared to be greater when the trunk extensor muscles were fatigued compared to the abdominal muscles. No statistically significant changes in trunk proprioception were found after either fatigue protocol. The present findings demonstrate our body's ability to quickly adapt and reweight somatosensory information to maintain postural control and trunk proprioception, as well as illustrate the importance of considering the abdominal muscles, along with the trunk extensor muscles, when considering the impact of fatigue on trunk movement and postural control. [ABSTRACT FROM AUTHOR]

Purpose: Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia".Methods: 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance.Results: In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain (successful rate: 98.81%); the ultrasound ruled out hernia recurrence, but in three cases it diagnosed tendinitis of the rectus abdominis muscle.Conclusions: Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care. [ABSTRACT FROM AUTHOR]

Background: Rhabdomyolysis is characterized by muscle necrosis and release of intracellular constituents, causing muscle pain, weakness, and myoglobinuria. This can be attributed to muscle injury after strenuous exercise. If the abdominal wall is involved, clinical presentation may resemble an acute abdomen.Case: A 27-year-old woman, gravida 4 para 2, presented with swelling and pain of the mons pubis and abdominal pain after intense powerlifting 2 days prior. A computed tomography scan was performed, revealing abdominal wall inflammation. Although myoglobinuria was absent, there was high suspicion for rhabdomyolysis, which was confirmed by an elevated creatine kinase level. The patient improved after receiving intravenous fluids and abstaining from physical activity.Conclusion: Abdominal wall muscle injury resulting in rhabdomyolysis can imitate an acute abdomen in a healthy woman presenting with abdominal pain and swelling. [ABSTRACT FROM AUTHOR]

Core muscle injury/sports hernia/athletic pubalgia is an increasingly recognized source of pain, disability, and time lost from athletics. Groin pain among athletes, however, may be secondary to various etiologies. A thorough history and comprehensive physical examination, coupled with appropriate diagnostic imaging, may improve the diagnostic accuracy for patients who present with core muscular injuries. Outcomes of nonoperative management have not been well delineated, and multiple operative procedures have been discussed with varying return-to-athletic activity rates. In this review, we outline the clinical entity and treatment of core muscle injury and athletic pubalgia. In addition, we describe the relationship between athletic pubalgia and femoroacetabular impingement along with recent studies that have investigated the treatment of these related disorders. [ABSTRACT FROM AUTHOR]

Background: Right lower quadrant pain in young females presents a frequent diagnostic challenge for emergency physicians, with a broad differential and several important diagnoses. Using an "ultrasound first" imaging strategy can help decrease the use of computed tomography scans, with associated savings in radiation exposure, cost, and other resource use.Case Report: We report a case of right lower quadrant pain in a young woman. After her initial history and physical examination, appendicitis was the leading differential. A bedside ultrasound was performed, leading to the uncommon diagnosis of rectus abdominis muscle tear. The sonographic findings of a muscle tear include increase in size, loss of linear, homogeneous architecture, and decreased echogenicity. Making this diagnosis at the bedside using ultrasound obviated the need for further imaging, avoiding unnecessary radiation exposure, and decreasing emergency department length of stay and overall cost, while leading to a tailored treatment plan. Why Should an Emergency Physician Be Aware of This? Rectus abdominis tear is a cause of right lower quadrant pain that may mimic appendicitis and should be considered in patients with this complaint. The ability to make this diagnosis with bedside ultrasound may assist in several important patient-oriented outcomes. [ABSTRACT FROM AUTHOR]

Background Multiple studies suggest that transversus abdominis plane ( TAP) block (without intrathecal morphine) after Caesarean section ( CS) reduces post-operative morphine consumption. In our study, we wanted to compare the analgesic effect of TAP block with infiltration of the wound after CS. Methods We included 60 pregnant women scheduled for elective CS under spinal anaesthesia in a randomised, single-centre, double-blind study. Thirty patients received ultrasound-guided TAP block using 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml bilaterally and 20 ml normal saline as wound infiltration ( TAP group). The other 30 patients (the control group) received normal saline 20 ml bilaterally in the TAP, and 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml as wound infiltration. The main outcome was cumulative morphine consumption at 48 h after surgery. In addition, continuous morphine consumption, pain scores and side effects were registered. Results Fifty-seven patients completed the study. Cumulative morphine consumption at 48 h (mean ± standard deviation) was 41 ± 34 mg in the TAP group and 38 ± 27 mg in the control group ( P = 0.7); a difference of 3 mg (95% confidence interval −13 to 19 mg). Morphine consumption at any time up to 48 h was virtually identical in both groups. Side effects were similar, except for a higher degree of sedation in the TAP group ( P = 0.04). Conclusion Compared with wound infiltration with local anaesthetics, TAP block did not reduce cumulative morphine consumption following CS. The TAP block was associated with more pronounced sedation. [ABSTRACT FROM AUTHOR]

Background: Alterations in the neuromuscular control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is assumed to be the cause of approximately 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable. This study investigated postural and neuro- motor changes in trunk muscles during sudden upper limb loading in patients with CLBP. Methods: Electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 20 patients with CLBP and 20 asymptomatic individuals with eyes open (EO) and eyes closed (EC) conditions. Moreover, measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test at the significance level of 0.05. Results: In patients with CLBP, decreased electrical activity of the ES muscle was observed under both the EO and EC conditions and that of the TrA/IO muscle was observed under the EO condition (p< 0.05). Other findings included a shorter peak latency of the ES muscle in the EO condition and a greater increase in the peak latency of the ES muscle following the EC condition (p< 0.05). No significant differences were observed in COP and GRF measurements between the groups. Conclusion: Electrical muscle activity may indicate less stiffening or preparatory muscle activity in the trunk muscle of patients with CLBP. Altered latency of the muscle may lead to microtrauma of lumbar structures and CLBP. [ABSTRACT FROM AUTHOR]

The article presents research which examined the association of hip range of motion with the movements of injured female professional tennis players. Topics covered include the importance of adequate hip range of motion to the energy transfer of players. Also mentioned is the impact of repetitive rotational stresses in the players' lower extremities on the injuries that they incur.

Positron emission tomography (PET) is a functional imaging technique that can investigate the metabolic characteristics of tissues. Currently, PET images are acquired and co-registered with a computed tomography (CT) scan (PET-CT), which is employed for correction of attenuation and anatomical localization. In spite of the high negative predictive value of PET, false-positive results may occur; indeed, Fluorine 18 (F)-fluorodeoxyglucose (F-FDG) uptake is not specific to cancer. As F-FDG uptake may also be seen in non-malignant infectious or inflammatory processes, FDG-avid lesions may necessitate biopsy to confirm or rule out malignancy. However, some PET-positive lesions may have little or no correlative ultrasound (US) and/or CT findings (i.e., low conspicuity on morphological imaging). Since it is not possible to perform biopsy under PET guidance alone, owing to intrinsic technical limitations, PET information has to be integrated into a CT- or US-guided biopsy procedure (multimodal US/PET-CT fusion imaging). The purpose of this pictorial essay is to describe the technique of multimodal imaging fusion between real-time US and PET/CT, and to provide an overview of the clinical settings in which this multimodal integration may be useful in guiding biopsy procedures in PET-positive abdominal lesions. [ABSTRACT FROM AUTHOR]

Full-thickness abdominal wall defects complicated with bowel exposure require a stable reconstruction that may be achieved with mesh repair, muscle rotational flaps, pedicled flaps, freeflaps or any combination of these techniques. We present a case report of a complex abdominal wound caused by a gunshot trauma in an elderly patient. His general health condition and local disruption of the left rectus, external, internal oblique and transverse abdominis muscles prevent local flaps or major surgical reconstruction procedures. The combined use in multiple stages of a homologous fascia lata graft, negative pressure therapy and acellular dermal substitute template followed by skin graft allowed stable wound healing. Level of Evidence: Level V, therapeutic study [ABSTRACT FROM AUTHOR]

Background: Abdominal wall hernia repair after open abdomen management represents a surgical challenge, particularly due to muscle tension and lateral retraction. This study was designed to propose the use of Botulinum Toxin Type A (BTA) before abdominal wall hernia repair. Methods: A prospective study of patients with abdominal wall hernia after open abdomen management was undertaken between September 2007 and January 2009. Bilateral BTA application was performed under electromyographic guidance at the abdominal wall. Transverse abdominal wall defect measurement was practiced at weekly intervals: clinically, in the first two patients, and with CT scan in the following 10 patients. Surgical closure was scheduled if no further hernia defect reduction was noted. Patients were followed at monthly hospital visits. Results: In the first two patients, a hernia defect reduction of 50 and 47.2%, respectively, was documented by the third week after BTA application, with no further reduction. In the 10 patients under CT scan hernia defect measurement, when comparing the initial mean transverse defect measure and at 4 weeks after BTA application (13.85 ± 1.49 cm vs. 8.6 ± 2.07 cm), an overall mean reduction of 5.25 ± 2.32 cm was observed ( p < 0.001; 95% confidence interval, 3.59-6.91). Hernia repair was performed, with no recurrences at a mean follow-up of 9.08 months. Conclusions: BTA application before abdominal wall hernia repair seems to be useful. The lateral muscles paralysis achieved and transverse hernia defect reduction allows a minimal tension closure. To our knowledge, this is the first report of BTA application before abdominal wall hernia reconstruction. [ABSTRACT FROM AUTHOR]

Background: With the growth and sophistication of laparoscopic surgery, increased attention is now being focused on safety and complications.Methods: In an attempt to address questions regarding the safety of laparoscopic surgery, a retrospective study of the time period from January 1991 to December 1995 was conducted by the Study Group of Endoscopic Surgery in Kyushu, Japan.Results: The response rate was 84.4% (152 of 180 hospitals). During the last 5 years 17,626 patients underwent endoscopic operations and 87.5% (15, 422 patients) had laparoscopic surgery while 12.5% (2,204 patients) underwent thoracoscopic surgery. In 96.6% of the hospitals a minimal open laparotomy was used. Among the various operations, a cholecystectomy was performed in the largest number of patients (13, 787). The total number of complications was 415 (2.7%), of which 156 (37.6%) were related to needle or trocar insertion. Visceral injury was found in 22 patients (0.14%): major vessel injury in 10, gastrointestinal tract injury in 11, and liver injury in one patient. Abdominal wall injury was seen in 79 patients (0.52%), bleeding in 70 (0.46%), and a hernia in 9 (0.06%). Extraperitoneal insufflation occurred in 55 patients (0.36%). There was no mortality. The complication rate significantly decreased year by year after the use of laparoscopic surgery began.Conclusions: The most common complications of laparoscopic surgery are related to needle and trocar insertion. These are preventable by placement under direct vision with verification of the intraperitoneal location of the needle and trocar. [ABSTRACT FROM AUTHOR]

The prune belly syndrome is a rare congenital anomaly which is characterized by the triad of an absent or a deficient development of the abdominal muscle, bilateral cryptorchidism and an anomalous urinary tract. In its full form, this condition occurs only in males. However, a similar condition occurs in females in the absence of cryptorchidism. On the other hand, the urorectal septum malformation sequence is a lethal congenital malformation which is characterized by the development of a phallus like structure, a smooth perineum and the absence of urethral, vaginal and anal openings. We are reporting a case of a female foetus with the prune belly syndrome, which was associated with a urorectal septum malformation sequence. A dead foetus with a protruded abdomen and ambiguous genitalia, was born at 32 weeks of pregnancy. On autopsy, it was found to have female internal genital organs. The left kidney, the urinary bladder and the rectum were absent. The sigmoid colon, the ureters and the fallopian tubes opened into a common cloacal sac. The histopathological examination of the ovary showed the presence of Leydig's cells. The occurrence of the female counterpart of the prune belly syndrome is extremely rare and only few of such cases were found to be discussed in the details in the indexed English literature so far. Hence, we hope that this case report will contribute to the existing knowledge on the prune belly syndrome. [ABSTRACT FROM AUTHOR]

Objective:To determine the frequency of this complication in two localsurgical setups, and to review and identify risk factors responsible for the calculated rate. Material and Methods: This descriptive study was carried out in the Department of Surgery, LiaquatUniversityHospital and Isra University, Jamshoro / Hyderabadfrom June 2011 to January 2012. The study included patients undergoing emergency or elective abdominal laparotomy. These patients were followed for postoperative complications up to one month. Patients who developed abdominal wound dehiscence were further analyzed to calculate its frequency and associated factors Results: During the study period, 98 patients underwent laparotomy with axillaryclearance as per inclusion criteria. The age of patients ranged from 19 years to 78 years, with mean age 30.65 years. Out of total 98 patients 58 were males and rest were females. Overall rate of wound dehiscence was 7.14% (7 out of 98). The rate was more in emergency laparotomy (9.09%) as compared to the non-emergency laparotomy procedures. The analysis of data showed that the most common risk factor associated with the wound dehiscence was wound sepsis (29.6%), followed by the chest infection (24.1%), old age (22.2%) and uremia (20%) accordingly. Most common complication following wound dehiscence was wound sepsis (87.5%) followed by intra abdominal abscesses (50%). Conclusion:Abdominal wound dehiscence is a morbid complication of the abdominal laparotomy. The preventable contributory factors should be apprehended before surgery to avoid this complication. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with abdominal wall hematomas in older adults that are associated with low molecular weight heparins.

The article discusses the treatment of an umbilical hernia, and it mentions the use of a surgical mesh material to provide support to a weakened abdominal wall during a hernia repair procedure. According to the article, a hernia is a defect in the muscles and connective tissue of the abdomen. It states that chronic coughing, obesity, and cirrhosis of the liver can cause umbilical hernias in patients.

An abstract of the article "A Retrospective Analysis of Risk Factors for IPP Reservoir Entry Into the Peritoneum After Posterior to Transversalis Fascia Placement" by M. S. Gross and colleagues is presented.