Re: Tubal failures
From: art fougner, md (evsono@pipeline.com)
Tue Aug 24 09:07:34 2004
There's also evidence that the timing of the procedure, post partum vs
interval is important. there were fewer failures when partial
salpingectomy was performed post-partum than during interval
sterilization. AmJObstetGynecol vol 174 April 1996 p1161.
art
At Tue, 24 Aug 2004, Braun, R. Daniel wrote:
>
>Concur with everything you say. We teach our residents to use "Plain" Catgut for Pomeroy's because it disappears sooner than Chromic and will allow the tubal ends to fall apart sooner.
>I am still trying to find a study that shows the failure rate is inversely proportional to the length of tube removed.
>
>Dan
>R. Daniel Braun, MD
>
>"If everyone likes you, you're doing something wrong."
>
>Kinky Friedman
>
>I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude.
>
>Andy Rooney
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Bülent Potur
> Sent: Monday, August 23, 2004 3:23 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Tubal failures
>
> Well if you use bipolar coagulation you should "Coagulate at least 3 contiguous areas of a minimum of 2cm to 3cm of tube, approximately 2cm to 3cm from the uterotubal junction." (1)
> If you perform a pomeroy ligation you should resect a whole segment of the tube not only a portion of the tubal wall. This is also true for silastic rings of Yoon. And also it is better to use chromic gut in pomeroy procedures. When it is healed the remaining segments are well apart and ocluded because of thre inflammatory reaction of catgut. On the other hand if you use silk or similar material these hold the cut ends of the tubes close to each other and may lead to spontaneous recanalizations.- personal experience.-
>
> Op. Dr. Bülent Potur
> http://web/ttnet.net.tr/bpotur/emain.htm
>
> 1) http://www..medscape.com/viewarticle/408874_print#Tab1 <http://www.medscape.com/viewarticle/408874_print#Tab1> :
>
> Tubal Occlusion Failures: Implications of the CREST Study on Reducing the Risk
>
> Charles S. Carignan, MD, Sangeeta Pati, MD, AVSC International <http://www.avsc.org/avsc/index.html> , New York City.
>
> Medscape General Medicine 1(2), 1999. © 1999 Medscape
>
>>> ----- Original Message -----
> From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> To: Multiple recipients of list OB-GYN-L <mailto:ob-gyn-l@dns.obgyn.net>
> Sent: Monday, August 23, 2004 9:22 PM
> Subject: RE: Tubal failures
>
> That is stating that success of reanastomosis goes up if what is left behind is greater than 2 cm. I am looking for a paper which says that the failure rate is inversely proportional to the length of the segment removed. I know it is out there but I can't find it.
>
> Dan
>
>Factors Affecting Success of Tubal Sterilization Reversibility
>
>* Method of Sterilization-most successful for Hulka clips, followed by rings, and then cautery and Pomeroy-type technique
>* Length of Tube-more successful when residual tube is longer than 2 centimeters
>
> R. Daniel Braun, MD
>
> "If everyone likes you, you're doing something wrong."
>
> Kinky Friedman
>
> I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude.
>
> Andy Rooney
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Bülent Potur
> Sent: Monday, August 23, 2004 12:17 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Tubal failures
>
> Dear Dan,
> I just tried google.(http://www.google.com) And searched "tubal sterilization failure " There is a 2 cm remark in the publication below.
> http://www.arhp.org/healthcareproviders/cme/onlinecme/sterilizationcp/hi tory.cfm?IDG
> I am sure you can find more.
> Take care.
> Regards,
> Bulent Potur MD
> http://medpages.obgyn.net/bpotur
>
>>> ----- Original Message -----
> From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> To: Multiple recipients of list OB-GYN-L <mailto:ob-gyn-l@dns.obgyn.net>
> Sent: Monday, August 23, 2004 5:22 PM
> Subject: Tubal failures
>
> Does anybody have a reference for an article that correlates length of tubal segment removed with subsequent failure rate? I remember such an article but I can't find it through PubMed. I don't know if I am searching incorrectly or what.
>
> Thanks,
> Dan
>
> R. Daniel Braun, MD FACOG
>
> Professor of Clinical Obstetrics and Gynecology
> Department of Obstetrics and Gynecology
> Indiana University School of Medicine
> Indianapolis, Indiana
--
art fougner, md
ich bin ein New Yorker
