Re: One layer uterine closure
From: Bernard Cristalli (bcrist@club-internet.fr)
Sat Sep 2 05:27:13 2006
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Have you got prospective randomized controlled trials proving double
layer is better?
BC
Kokumo Oyakhire a écrit :
> My patients and I would prefer the time honoured two layered unlocked
> closure. I do not mind change(s), but any change in practice should
> have gone through ethically approved researches, at least controlled
> trials. Even the SPCAs still protect there patients.
>
> */"D. Ashley Hill" <dahmd@cfl.rr.com>/* wrote:
>
> Heresy. Actually, I have not locked uterine incisions for over 12
> years
> (you have me beat by a long shot) due to concerns about tissue
> necrosis.
> Everyone asks "what about hemostasis." If you observe the tissue after
> you have completed with your incision line it's obvious if it's
> bleeding
> or not (usually not). What's equally interesting to me is the variety
> of suture material. I know someone who uses 3-0 vicryl for the uterus,
> whereas I use 0-chromic. I guess we're all victims of our training.
>
> Ashley
>
> At Fri, 1 Sep 2006, R. Daniel Braun wrote:
> >
> >One needs to ask are these ONE layer LOCKING sutures or one layer
> NO-LOCKING
> >sutures?
> >I bet the bad results were with locking and the good ones with
> non-locking.
> >
> >Just my opinion and over 40 years observation.
> >
> >Dan
> >
> >On 9/1/06, Dr. Cesar Molina wrote:
> >>
> >> I am a obstetric and gynecologyc surgeon in Costa Rica and have two
> >> experiences with one layer uterine closure. For differente
> >> circumstances I have to open this patients 7 and 8 days after the
> >> section. It was very impressionant the irregular and bad aspect of
> >> uterine scarr healing in two cases. Although the inmediate
> evolution
> >> of the patients was good after reintervention(late evolution I
> don`t
> >> know), I felt very much concerned about the future evolution of
> their
> >> abdominal cavities. My impression was that this two patiens will
> >> depelop an important adherential syndrome. What is your experience
> >> about??
> >>
> >> At Sun, 10 Jun 2001, art fougner, md wrote:
> >> >
> >> >germans had an entirely different experience -
> >> >
> >> >1: Zentralbl Gynakol 1986;108(17):1039-45
> >> >
> >> >[Clinical experiences with a single layer uterine suture in
> cesarean
> >> >section].
> >> >
> >> >[Article in German]
> >> >
> >> >Winkler M, Ruckhaberle KE, Saul S, Forberg J.
> >> >
> >> >In this analysis 536 caesarean sections with a single layer
> uterine
> >> >suture were compared to 256 sections with two layer closure. Their
> >> >relations with regard to indications of operative delivery,
> >> >complications during the puerperium and their courses in
> subsequent
> >> >vaginal deliveries were taken into consideration. - The
> significant
> >> >lower rate of pyrexia and shorter hospital stay of the
> patients may be a
> >> >result of quicker and better healing of the single layer
> suture. The
> >> >increased rate of complications in the puerperium is partially
> due to
> >> >changes in the registry of dates. Absent disturbances during the
> >> >placental period and the occurrence of only one uterine
> rupture, in the
> >> >course of vaginal delivery in a patient with a previous single
> layer
> >> >caesarean section suture, demonstrates the functional
> sufficiency of
> >> >this technic.
> >> >
> >> >PMID: 3538711 [PubMed - indexed for MEDLINE]
> >> >
> >> >seems reasonable to perform a formal trial.
> >> >
> >> >art
> >> >
> >> >At Sun, 10 Jun 2001, Steve Raymond wrote:
> >> >>
> >> >>Yes, and we are considering enrolling, but we had an
> experience about
> >> four years
> >> >>ago when one of the rural hospitals that refers to us decided
> to start
> >> one layer
> >> >>closures after reading about the Misgav-Ladach technique. We
> found after
> >> a few
> >> >>months that they were suddenly sending us problem cases of
> bleeding and
> >> failure
> >> >>of healing and such like, which had us mystified until they
> informed us
> >> of the
> >> >>change in technique, of which we had not previously been aware.
> >> >>
> >> >>Seems to me that they should have an ethical committee ruling
> on this!
> >> >>stray
> >> >>
> >> >>> The CAESAR study is recruiting in UK, is it not?
> >> >>>
> >> >>> Rupak Ranjan Roy
> >> >>> MRCOG
> >> >>
> >> >>--
> >> >>
> >> >>Dr.S.H. Raymond
> >> >>Head of Department of O & G
> >> >>Empangeni Hospital
> >> >>South Africa 3880
> >> >>Phone: (+27) 35-7721111
> >> >>Fax: (+27) 35-7922596
> >> >>
> >> >--
> >> >art fougner, md
> >> >
> >> >A series of 1000 cases begins with but a single anecdote.
> >> >
> >>
> >--
> >R. Daniel Braun
> >
> > "The way to health is an aromatic bath and scented massage
> everyday".
> > Hippocrates
> >
>
> --
> D. Ashley Hill, MD
> Associate Director
> Department of Obstetrics and Gynecology
> Florida Hospital Family Practice Residency
> Medical Director, Loch Haven Ob/Gyn Group
> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
> Orlando, Florida
>
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