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Re: Single Layer vs Double Layer Uterine Closure From: Dr. Bülent Potur (bpotur@ttnet.net.tr) Mon Nov 10 10:15:49 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Single Layer vs Double Layer Uterine Closure" Previous message: Bernard Cristalli: "Re: Single Layer vs Double Layer Uterine Closure" In reply to: Braun, R. Daniel: "Re: Single Layer vs Double Layer Uterine Closure" There is #2 chromic here. Though they are not so well standardized. The reason I choose it because I was trained that way. Secondly it is more strong and reliable. Third because the patient population here is so diverse and there is always a risk of infection. Nearly ten years ago vicryl was not available in our hospital and we would sew the fascia with #2 chromic. There had been a wound infection following a prolonged labor with resultant inscisional hernia. So I do not have much confidence in chormic. Two rows make me feel more secure and comfortable. Yes MGL operation advovates only one layer then I think I would use #1 or #2 polygycolc acid but I remember that several years ago in this list a suture of this kind protruding from vagina had been reported several months post operation. The only positive mark of MGL procedure for me, has been the tying of 5-7 knots of #1 or #2 vicryl beneath the fascia. So the patients do not ask any more about the undesolvable protuberence beneath the skin of the corners of the inscision. The negative point has been that the nursing and paramedical staff in the operating theater are looking weirdly to me and they say to each other that I tear the patient. Two years ago I had met Dr. Israel Meisner( http://www.fetal-tumors.com/ ) at Istanbul. He had told me that he did not perform ML operations himself.And Misgav Ladach Hospital was bankrupt and closed. I hope that it was not the curse of the operation. At Mon, 10 Nov 2003, Braun, R. Daniel wrote: > >-----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: >> >>but you aren't teaching residents on a day to day basis. > >-- >Bülent Potur M.D. Obgyn. http://medpages.obgyn.net/docdetail.cfm?sn=424 > -- Bülent Potur M.D. Obgyn. http://medpages.obgyn.net/docdetail.cfm?sn=424 Next message: Joanne Bulley, MD: "Re: Single Layer vs Double Layer Uterine Closure" Previous message: Bernard Cristalli: "Re: Single Layer vs Double Layer Uterine Closure" In reply to: Braun, R. Daniel: "Re: Single Layer vs Double Layer Uterine Closure"

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