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Re: Single Layer vs Double Layer Uterine ClosureFrom: Braun, R. Daniel (rbraun@iupui.edu)Mon Nov 10 04:46:37 2003
-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Bülent Potur Sent: Sunday, November 09, 2003 12:09 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Single Layer vs Double Layer Uterine Closure Speaking of teaching residents in my previous e-mail I had mentioned Misgav Ladach procedure. How many of you use it as a standard C/S procedure? With slight variations. What percentage of you teach it to residents? I do. I ask this because in some scientific meetings around here it is mentioned and pioneered as a brand new invention of modern obstetrics adding speed and naturality to the operations. As to the uterine angles, I place one separate no 2 chromic through whole thicknes of myometrium at each angle under direct vision. Then first layer No: 2 chromic contiuous locking, No. 2 ???????????? No.1 is the biggest that I can get. Second layer No:1 Chromic non locking but burying, visceral peritoneum No 0 chromic locking with a small bite of myometrium. On repeat sections of uteri sectioned this way low segment is generally quite thin. M-L doesn't use a second layer or close the peritoneum, that I was aware of. Then 1 st layer No:1 Chromic locking, peritoneum No:0 locking. We generally perform Pomeroys' at the third section. I would like to ask Dan how he tackles let's say the extended tear of left uterine angle with ruptured and pulsating left uterine artery. Do you isolate and separately ligate the artery or do you prefer to bury it within figure of eight separate sutures? Simple suture or fig. of eight and then run that suture across as my single layer running closure stitch.
>At Fri, 7 Nov 2003, Braun, R. Daniel wrote:
-- Bülent Potur M.D. Obgyn. http://medpages.obgyn.net/docdetail.cfm?sn=424
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