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Re: OB didelphyic/bicornuate and breech --> type of incision? From: Raymond Stephen (Stephen.Raymond@dhhs.tas.gov.au) Tue Jul 29 08:33:31 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joe: "Re: forceps, fibroids, skull fracture" Previous message: art fougner, md: "GYN: Name Your Poison" In reply to: rmodugno@aol.com: "Re: OB didelphyic/bicornuate and breech --> type of incision?" Next in thread: Dr Eberhard W Lisse: "Re: OB didelphyic/bicornuate and breech --> type of incision?" The best approach in an obese patient in obstetrics is the one that allows you to do what you have to do without postoperative risks. In my view that means avoiding a midline, because you only need access to the lower segment and sufficient width to deliver the baby. If you need greater access than that, such as in a placenta percreta where you will probably need access to the upper segment, then you have to accept second best and do your midline. I too close midlines with a "loop nylon or PDS" and hope and pray that they don't get infected - terrible situation if the patient is obese and/or diabetic! Steve Raymond Ph (03)62227898 Cell 0438372395 ________________________________ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of -- ________________________________ rmodugno@aol.com Sent: Monday, 28 July 2008 11:01 PM To: Multiple recipients of list OB-GYN-L Subject: Re: OB didelphyic/bicornuate and breech --> type of incision? >----- Original Message ----- From: "Raymond Stephen" <Stephen.Raymond@dhhs.tas.gov.au> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> Sent: Sunday, July 27, 2008 10:18 PM Subject: Re: OB didelphyic/bicornuate and breech --> type of incision? > If you really were "free to use incisions that work the best for my > patient, my o.r. crew, and myself" then you would have to acknowledge > that there may be a conflict between what is best for you patient and > what is best for you. As I said before a midline in an obese patient is > definitely not best for her, in obstetrics. I spent much of my time as > a senior registrar fixing burst abdomens after my consultant had done > his "best for him" midline incisions. > > Steve Raymond > *************************** =20 Ah, Steve, time has passed since your senior registrar days! Suture materials have changed. When I do a midline incision in obese patients ( and that's not all the time!), I have used a mass closure using double-stranded #1 PDS with success. So what is the "best" approach to pelvic surgery, OB & GYN, in the obese patient? Robert Modugno MD MBA FACOG Sylva, NC ________________________________ The Famous, the Infamous, the Lame - in your browser. Get the TMZ ________________________________ Toolbar Now CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. Next message: Joe: "Re: forceps, fibroids, skull fracture" Previous message: art fougner, md: "GYN: Name Your Poison" In reply to: rmodugno@aol.com: "Re: OB didelphyic/bicornuate and breech --> type of incision?" Next in thread: Dr Eberhard W Lisse: "Re: OB didelphyic/bicornuate and breech --> type of incision?"

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