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Re: colpocleisis From: Malcolm Griffiths (obsdoc@doctors.org.uk) Wed Jan 19 15:38:20 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Malcolm Griffiths: "Re: Labor induction in fetal death and placenta praevia" Previous message: Malcolm Griffiths: "Re: Fire the Boss and Break the Alarm Clock!" I am unable to quote either very long-term complication rates for my surgery - I have only held my presnt post for 5.5 years. I am able to describe my surgical outcomes both short & long-term in the same anecdotal detail as others. My results are comparable to those one would expect. There seems to be a split between vaginal surgeons who pay considerable attention to detail and those who perform the surgical steps to accoplish either removal of the organ in question or removal of the organ and steps to address prolapse. This is not a UK vs USA split but seems to be present on both sides of the pond. I am unaware of any evidence of improved outcome by such "detailists". We have one such detailist in our own unit. His vaginal hysterectomies are often spoken of, though not generally positively by his assistants. I am unaware of any evidence of better outcomes. On the contrary I am well aware that my patients not infrequently are well and home before his. I have no disrespect at all for his approach and am fairly certain that he achieves a small reduction in immediate post-operative morbidity as a result of his approach. My view is that such a benefit must be traded off against the possibility of (in our NHS environment) of increased surgical throughput (by an order of >2 fold). However (as Bernard might say) "returnon a nos mouton" (let's get back to what we were talking about). The issue being discussed was the use of Le Fort colpocleisis in an elderly demented patient. There seem to be two distinct opinions on this one: 1 Do the above procedure under local anaesthesia and complete it in about 20 minutes. 2 (My view) that major or intermediate surgery in a demented patient cannot be done under anything but GA or very heavy sedation. A colpocleisis takes about as long as a speedy vag hyst (probably longer). It is almost certain not to be associated with any greater surgical risk and is much more likely to produce an enduring and satisfactory result. I happened to be discussing this issue with my female Indian resident. She is over in UK to gain more experience in some areas but has seen and done lots in India. She is perfectly competent in routine vaginal surgery and has the advantage over me (certainly and possibly some others). She has done a number of Le Forts. She tells me that they take longer to do than a simple vaginal hysterectomy in a patient with gross prolapse! -- Malcolm GRIFFITHS, Ob/Gyn E-mail obsdoc@doctors.org.uk Dept of Obs & Gynae +44(0)1582-497533 (Sec) 21, School Lane, Luton & Dunstable Hospital, +44(0)1582-497376 (Fax/me) Eaton Bray, Lewsey Road, +44(0)1525-222849 (Home) DUNSTABLE, LUTON, LU4 0DZ.. +44(0)1525-222643 (Fax) Beds., LU6 2DT.. >----- Original Message ----- From: Zach Newton <zbnewton@mindspring.com> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> Sent: Tuesday, January 18, 2000 12:42 AM Subject: Re: colpocleisis > > Malcolm Griffiths wrote: > > > The vaginal hysterectomy and anterior repair did take over 15-20 minutes > > (just) but that was because I let my resident do the surgery under my > > supervision! > > Malcolm- > > Your proficiency in operating time has been repeatedly referenced. > There is no doubt that your native co-ordination and focused drive > result in substantially above average, by miles, super-efficient > surgical time with, no doubt (sincere), better than average results. > Your braggadocio raises the question of emphasis on time to the neglect > of doing the extra steps that best serve long term results. > For instance, what proportion of your v.h. pts have uterosacral > plication? What is the incontinence rate 5 years out? What is > the re-operation rate for post-hysterectomy oophorectomy? What is your > rate of tubal prolapse? > > I expect on critical analysis, you have good numbers all the way around. > I am bothered by your benchmark being time rather that long term > outcome. When you win at both ends, you are really the champ. > > Of course, the problem exists for all of us: we never know, because our > failures go elsewhere for resolution. > > I do salute your exceptional operative efficiency. By any measure, you > are good. > > Zach Newton > Z. B. Newton, III, M.D. > Atlanta/Gyn > Next message: Malcolm Griffiths: "Re: Labor induction in fetal death and placenta praevia" Previous message: Malcolm Griffiths: "Re: Fire the Boss and Break the Alarm Clock!"

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