OB-GYN-L Messages for August, 2005: Re: Catgut

Re: Catgut

From: Efrain Ramirez

eramirezt@coqui.net

Tue Aug 9 19:27:16 2005

(Replaces Technical Bulletin Number 222, April 1996)

The CREST data reported that the 10-year cumulative probability for sterilization failure varied by sterilization method and ranged from 7.5 per 1,000 to 36 per 1,000 procedures. Postpartum partial salpingectomy had the lowest 5-year and 10-year cumulative pregnancy rates: 6.3 per 1,000 and 7.5 per 1,000 procedures, respectively. The 5-year and 10-year pregnancy rates, respectively, for other occlusion methods are as follows (43):

Bipolar coagulation: 16.5 per 1,000 and 24.8 per 1,000 procedures Silicone band methods: 10 per 1,000 and 17.7 per 1,000 procedures Spring clip: 31.7 per 1,000 and 36.5 per 1,000 procedures

Secondary analysis of 5-year failure rates with bipolar coagulation performed in different decades found that failure was significantly lower in later periods, reflecting improved technique with the method: 19.5 per 1,000 procedures for 1978–1982 versus 6.3 per 1,000 procedures for 1985–1987 (16). The 10-year cumulative risk of pregnancy was highest among women sterilized at a young age with bipolar coagulation (54.3/1,000) and clip application (52.1/1,000). The study cautions that the reported failure rates should not be considered in isolation of other variables that influence overall outcome. A

t Tue, 9 Aug 2005, art fougner, md wrote: >
>According to Cochrane there are no trials large enough to assess. In
>the one trial comparing Fishlie and Pomeroy, there was one pregnancy in
>the Pomeroy group, none in the Fishlie group. However, I will happily
>defer to those with more experience in this area.
>
>art
>
>At Tue, 9 Aug 2005, Efrain Ramirez wrote:
>>
>>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.
>>>>>
>>>>>************************************************************************
>>>>>****
>>>>>************************************************************************

>>>>>************************************************************************
>>>>>************************************************************************
>>>>>************************************************************************
>>>>>************************************************************************
>>>>>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~
>>
>--
>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~

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