Re: Catgut
From: Efrain Ramirez (eramirezt@coqui.net)
Tue Aug 9 16:51:44 2005
I think the Filshie clips have the highest failure rates..??
>At Tue, 9 Aug 2005, art fougner, md wrote:
>
>EBM Reviews - Cochrane Central Register of Controlled Trials
>Accession Number CN-00469678
>
>Author Kohaut BA, Musselman BL, Sanchez-Ramos L, Kaunitz AM
>Institution Department of Obstetrics and Gynecology, University of
>Florida Health Science Center/Jacksonville, 3627 University Boulevard
>South, Suite #355, Jacksonville, FL 32216, USA.
>
>Title Randomized trial to compare perioperative outcomes of Filshie clip
>vs. Pomeroy technique for postpartum and intraoperative cesarean tubal
>sterilization: a pilot study.
>Source Contraception. 69(4):267-70, 2004 Apr.
>
>Abstract OBJECTIVE: To compare, by conducting a randomized trial,
>Filshie clip and Pomeroy techniques for postpartum and intrapartum
>cesarean sterilizations in a United States teaching hospital with
>respect to surgeon preference and perioperative outcomes. METHOD:
>Thirty-two obstetric patients consented for sterilization were
>randomized to Pomeroy technique or Filshie clip placement. Following
>the surgical procedure, surgeons and operating room technicians
>completed a survey regarding their experience with the procedures and
>preference. Patient demographic data, time for procedure and follow-up
>visits were obtained by chart review. RESULTS: For most postpartum
>sterilizations, the mean duration of the procedure was almost 7 min
>faster for the Filshie clip technique (p = 0.08); perioperative outcomes
>were equivalent (p = 0.05). Application of the Filshie clip was rated
>easier than Pomeroy suture application and, overall, the Filshie clip
>sterilization procedure was rated less difficult (p = 0.03). Seventy
>percent of surgeons preferred the Filshie clip technique and would
>choose it if only one postpartum sterilization method was available.
>CONCLUSION: For obstetric sterilization, surgeons preferred the Filshie
>clip over the Pomeroy technique. In addition, operating time was
>shorter for the Filshie clip. This pilot study suggests that use of the
>Filshie clip technique has the potential to establish a new standard of
>care for postpartum and intrapartum cesarean sterilization.
>
>hope this helps the discussion.
>
>art
>
>At Tue, 9 Aug 2005, ainsron wrote:
>>
>>No, they have been easy to place, just fan out the tube.
>>
>>Ronald E. Ainsworth, MD, FACOG
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod
>>Darryl G MAJ 48 MDOS/SGOBO
>>Sent: Tuesday, August 09, 2005 12:03 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Catgut
>>
>>Hulka clips at c-section? I wonder why that was never taught before? It
>>makes perfect sense. Do you think you have any more problems with placement
>>because of the size of the tube at delivery?
>>
>>Glen
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
>>Sent: Monday, August 08, 2005 4:22 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Catgut
>>
>>I do the same. However, I've quit using the Pomeroy technique for PPTLs and
>>TLs at the time of C/S. I now use the Hulka Clips, quick, simple and
>
>>bloodless.
>>
>>Ronald E. Ainsworth, MD, FACOG
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>>Ramirez
>>Sent: Monday, August 08, 2005 7:59 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Catgut
>>
>>I also use plain for Pomeroy's -- I don't Vicryl is a good choice for it
>>unless one is doing Parkland...
>>
>>>At Mon, 8 Aug 2005, Charlie Chambers wrote:
>>>
>>>Yep, plain gut for Pomeroy's. Any modification has merely decreased the
>>>efficacy, such as other suture materials, cautery of the cut ends, etc.
>>>
>>>************************************************************************
>>>****
>>>************************************************************************
>>>************************************************************************
>>>************************************************************************
>>>
>>>--
>>>Charlie Chambers
>>>Hood River, OR USA
>>>cchamber@alumni.rice.edu
>>>
>>>"...not because I regard fishing as being so terribly
>>>important but because I suspect that so many of the other
>>>concerns of men are equally unimportant-and not nearly
>>>so much fun."
>>> John Voelker
>>>************************************************************************
>>>*****
>>>************************************************************************
>>>************************************************************************
>>>************************************************************************
>>>On Aug 8, 2005, at 4:17 AM, Larry Glazerman wrote:
>>>
>>>> My understanding is that the original work by Pomeroy used the fact
>>>> that when catgut was used, the two ends of the tube didn't stay in
>>>> approximation for very long, therefore the risk of fistula was
>>>> decreased. I can't prove that, but that's why I remember always using
>>>> catgut for tubals
>>>>
>>>> Larry R. Glazerman, MD
>>>>
>>>> Ob-Gyn at Trexlertown, PC
>>>>
>>>> 610-402-0161
>>>>
>>>> l.glazerman@rcn.com
>>>>
>>>> <unknown.jpg>
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>> Bernard Cristalli
>>>> Sent: Monday, August 08, 2005 2:59 AM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: Re: Catgut
>>>>
>>>> That's gambling.
>>>> What you want is temporary TL?
>>>> BC
>>>>
>>>> Elrod Darryl G MAJ 48 MDOS/SGOBO a écrit :
>>>>
>>>> I only use plain gut for postpartum or c-section tubal ligations. I
>>>> can't think of any place else it would benefit.
>>>>
>>>> Glen
>>>>
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>> Henry Gregor
>>>> Sent: Friday, August 05, 2005 8:38 PM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: Catgut
>>>>
>>>> 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:
>>>>> 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
>>>>>
>>>>> Dear colleagues:
>>>>> A new outlook on parietal peritoneum closure in c-section:
>>>>>
>>>>> http://www.pslgroup.com/dg/251a56.htm
>>>>>
>>>>> I'd like to know your opinion on this matter (here, in my country,
>>>>> we still discuss about it).
>>>>>
>>>>> Julio C. Arellano
>>>>>
>>>>> La Plata. Buenos Aires.
>>>>> Argentina.
>>>>> arellano@netverk.com.ar
>>>>>
>>>>> "Good judgment comes from experience, and often experience comes
>>>>> from bad judgment."
>>>>> Rita Mae Brown
>>>>>
>>>>> <imstp_emo_es.gif>
>>>
>>--
>>"Character may be manifested in the great moments, but it is made in the
>>small ones."
>>
>> - Phillip Brooks
>>
>> ~walt whitman~
>>
>--
>art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
>Lawrence Peter Berra
>
--
"Character may be manifested in the great moments, but it is made in the
small ones."
- Phillip Brooks
~walt whitman~
