Re: peritoneum

From: FRANCES WREN (fwren@shaw.ca)
Thu Mar 6 21:23:27 2008


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oh bother... conflicting stuff in different studies... to close or not close 2005 128 women..."to close is better" 2006 124 women..."to not close is better"

what to do... maybe it doesn't matter. frances wren

I shall keep looking...but interesting.

>----- Original Message -----
From: Ina May Gaskin <inamaygaskin@gmail.com> Date: Thursday, March 6, 2008 6:23 pm Subject: Re: peritoneum To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>

> Lyell DJ, et al. Peritoneal closure at primary cesarean delivery
> and
> adhesions Obstet Gynecol 2005;106:275-80.
>
> A prospective study of 173 cohort of women having first repeat c-
>
> section. Severity and location of adhesions were scored just
> after
> delivery. Records were then examined to assess prior
> surgical
> technique. A total of 128 women was required to have 80% power
> to
> detect a 505 reduction in adhesions when parietal peritoneum was
> left
> open.
>
> Conclusion: Parietal peritoneal closure at primary c-sec was 5-
> fold
> protective against all adhesions and 3-fold protective against
> dense
> adhesions. Omental-fascial adhesions were decreased most
> consistently. "The practice of nonclosure of the parietal
> peritoneum
> at cesarean delivery should be questioned."
> Level of Evidence II-2.
>
> Ina May
>
> On 6 Mar 2008, at 11:42, FRANCES WREN wrote:
>
> > for years I neatly sewed up the parietal peritoneum at C/S (25 yrs+)
> > then within the last 1-2 years started , as it seemed
> the
> > literature had been advocating for some time , to leave it
> open and
> > just sew up the fascia.
> > this am I did a C/S ..I am doing a locum, and my assistant
> said
> > he'd heard that the'y revised the opinion of leaving the
> peritoneum
> > open and it was now...again...felt better to close it ..in
> terms of
> > adhesion formation.
> > certainly looks neater at the time when one closes
> it....but
> > quicker to not (besides I am now used to NOT closing it)
> >
> > I have not read anything recently saying to close it ..
> > any evidence re better to close or leave open????
> > opinions please.
> >
> > frances wrenMD FRCS.
>

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<DIV>oh bother...</DIV> <DIV>conflicting stuff in different studies...</DIV> <DIV>to close or not close</DIV> <DIV>2005&nbsp; 128 women..."to close is better"</DIV> <DIV>2006&nbsp; 124 women..."to not close is better"</DIV> <DIV>&nbsp;</DIV> <DIV>what to do...</DIV> <DIV>maybe it doesn't matter.</DIV> <DIV>frances wren</DIV> <DIV>&nbsp;</DIV> <DIV>I shall keep looking...but interesting.<BR><BR> >----- Original Message -----<BR>From: Ina May Gaskin &lt;inamaygaskin@gmail.com&gt;<BR>Date: Thursday, March 6, 2008 6:23 pm<BR>Subject: Re: peritoneum<BR>To: Multiple recipients of list OB-GYN-L &lt;ob-gyn-l@mail.obgyn.net&gt;<BR><BR>&gt; Lyell DJ, et al. Peritoneal closure at primary cesarean delivery <BR>&gt; and&nbsp; <BR>&gt; adhesions Obstet Gynecol 2005;106:275-80.<BR>&gt; <BR>&gt; A prospective study of 173 cohort of women having first repeat c-<BR>&gt; <BR>&gt; section. Severity and location of adhesions were scored just <BR>&gt; after&nbsp; <BR>&gt; delivery. Records were then examined to assess prior <BR>&gt; surgical&nbsp; <BR>&gt; technique. A total of 128 women was required to have 80% power <BR>&gt; to&nbsp; <BR>&gt; detect a 505 reduction in adhesions when parietal peritoneum was <BR>&gt; left&nbsp; <BR>&gt; open.<BR>&gt; <BR>&gt; Conclusion: Parietal peritoneal closure at primary c-sec was 5-<BR>&gt; fold&nbsp; <BR>&gt; protective against all adhesions and 3-fold protective against <BR>&gt; dense&nbsp; <BR>&gt; adhesions. Omental-fascial adhesions were decreased most&nbsp; <BR>&gt; consistently. "The practice of nonclosure of the parietal <BR>&gt; peritoneum&nbsp; <BR>&gt&
#059; at cesarean delivery should be questioned."<BR>&gt; Level of Evidence II-2.<BR>&gt; <BR>&gt; Ina May<BR>&gt; <BR>&gt; On 6 Mar 2008, at 11:42, FRANCES WREN wrote:<BR>&gt; <BR>&gt; &gt; for years I neatly sewed up the parietal peritoneum at C/S (25 yrs+)<BR>&gt; &gt; then within the last 1-2 years started , as it seemed <BR>&gt; the&nbsp; <BR>&gt; &gt; literature had been advocating for some time , to leave it <BR>&gt; open and&nbsp; <BR>&gt; &gt; just sew up the fascia.<BR>&gt; &gt; this am I did a C/S ..I am doing a locum, and my assistant <BR>&gt; said&nbsp; <BR>&gt; &gt; he'd heard that the'y revised the opinion of leaving the <BR>&gt; peritoneum&nbsp; <BR>&gt; &gt; open and it was now...again...felt better to close it ..in <BR>&gt; terms of&nbsp; <BR>&gt; &gt; adhesion formation.<BR>&gt; &gt; certainly looks neater at the time when one closes <BR>&gt; it....but&nbsp; <BR>&gt; &gt; quicker to not (besides I am now used to NOT closing it)<BR>&gt; &gt;<BR>&gt; &gt; I have not read anything recently saying to close it ..<BR>&gt; &gt; any evidence re better to close or leave open????<BR>&gt; & ;gt; opinions please.<BR>&gt; &gt;<BR>&gt; &gt; frances wrenMD FRCS.<BR>&gt; <BR>&gt; </DIV>

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