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CatgutFrom: Henry Gregor (henrygregor@yahoo.com)Fri Aug 5 14:19:38 2005
Good - very good - observations by Sam. Prompts the additional question of is there a desirable time/place/procedure in any surgery for which catgut would be a preferred suture? Probably not, I suspect but all thoughts welcome. Hank Gregor "Atkinson, Samuel M" <ATKINSONS@mail.ecu.edu> wrote: v\:* {behavior:url(#default#VML);}o\:* {behavior:url(#default#VML);}w\:* {behavior:url(#default#VML);}.shape {behavior:url(#default#VML);}st1\:*{behavior:url(#default#ieooui) }FLAVOR00-NONE-0000-0000-0000000000004.0; You will find the complete reference on the subject in the August issue of Obstetrics and Gynecology (The Green Journal on page 275.) Reference 6 is the article by Tulandi et al from Montreal published in 1988 in AJOG stated that there were more adhesions when the peritoneum was closed. In a recent publication letter to the editor they again referenced their article which, evidently very few people ever read. NO WONDER . They closed the peritoneum with PLAIN CATGUT-the most inflammatory suture one can use. To quote Michelle Duchinski in TeLinde “…disadvantages include intense inflammatory scarring ..” “Catgut should not be routinely used in gynecologic surgery. Indeed there remains little indication for the use of catgut in any gynecologic surgical procedure.” P 232, seventh edition. No wonder they found more adhesions in reperitonealized patients. Two horrible wrongs do not equal a right. At last, a level II data paper putting an end to this BS. I suspect our other subscriber who entered the bladder –when she looks up the previous OP note-will find that the peritoneum was not closed-thus the bladder was adherent to the ant abdominal wall and no way could one avoid a bladder entry. By using a monofilament, poly gycolic fine suture and not pulling the peritoneum up tight into a water tight seal, as many of us were taught in the dark ages, there will be significantly less adhesions than if one leaves the peritoneum open. Loosely approximate with non braided polyglycolic suture. Sam Atkinson ---------------------------------
--------------------------------- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Julio Arellano -- --------------------------------- Sent: Monday, August 01, 2005 10:39 PM To: Multiple recipients of list OB-GYN-L Subject: New paper - Peritoneum closure
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