Re: endometriosis in C/S scar
From: Gerald P. Rodriguez (geraldpr@cybermesa.com)
Tue Jul 30 16:25:19 2002
Gail,
I wouldn't necessarily expect the mesh to get infected, but I raised the
issue to Dan for two reasons:
1) I disagree that the expectation that in this clinical setting, one would
by reflex put in mesh. I've done a number of these and, at least in my
experience they are not that big a deal. In order to put in mesh, one is
going to be there a lot longer, do a lot more dissection of the fascia just
to prevent a hernia. Assuming the defect in the fascia is not huge, a hernia
is very unlikely to develop. The vast majority of these are going to occur
in a transverse incision. Close the fascial defect transversely and the
chance of an incisional hernia should be very low--not zero--but very low.
Obviously, if the endometrioma is huge and one is left with a fascial defect
that is marginally closeable, then by all means use mesh.
2) I have seen wound infections in which the mesh is infected. It is not a
trivial issue to deal with.
Gerald P. Rodríguez, M.D., FACOG
Santa Fe
>----- Original Message -----
From: "Gail Waldby" <gwaldby@willinet.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: Tuesday, July 30, 2002 2:55 PM
Subject: Re: endometriosis in C/S scar
> Gerald, why would you expect the mesh to get infected? Just have around
1% chance of mesh infection. If it happens, you remove the mesh.
> Prolene or Marlex mesh are rarely infected, even if the wound becomes
infected. Goretex mesh almost always becomes infected if the wound
> becomes infected.
> Gail Waldby, MD
> Huron Clinic SD
>
> 7/30/2002 9:37:30 AM, "Gerald P. Rodriguez" <geraldpr@cybermesa.com>
wrote:
>
> >And what do you do when the mesh gets infected?
> >
> >Gerald P. Rodríguez, M.D., FACOG
> >Santa Fe
> >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> >"There is something fascinating about science. One gets such wholesale
> >returns of conjecture out of such trifling investment of fact."
> >--Mark Twain
> >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> >
>> >----- Original Message -----
> >From: "Braun, R. Daniel" <rbraun@iupui.edu>
> >To: "Multiple recipients of list OB-GYN-L"
<ob-gyn-l@mail.medispecialty.com>
> >Sent: Tuesday, July 30, 2002 8:19 AM
> >Subject: RE: endometriosis in C/S scar
> >
> >> Me too for 35 years. Always under general.Never had a defect less than
5
> >cm in diameter after excision. According to the surgical literature and
also
> >one of the articles on last year's ABC recert. exam that requires mesh.
> >>
> >> Dan
> >>
> >> -----Original Message-----
> >> From: Gerald P. RodriguezTo: Multiple recipients of list OB-GYN-L
> >> Sent: 7/30/2002 9:04 AM
> >> Subject: Re: endometriosis in C/S scar
> >>
> >> Been doing them for 30 years; occasionally under general if hard to
> >> define.
> >> Try to do them during the luteal phase so that I have a fairly good
idea
> >> of
> >> how big they are. Never have used mesh; never had a hernia--that I
know
> >> of
> >> (?).
> >>
> >> Gerald P. Rodríguez, M.D., FACOG
> >> Santa Fe
> >>
>> >> ----- Original Message -----
> >> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> >> To: "Multiple recipients of list OB-GYN-L"
> >> <ob-gyn-l@mail.medispecialty.com>
> >> Sent: Tuesday, July 30, 2002 7:54 AM
> >> Subject: RE: endometriosis in C/S scar
> >>
> >> > How many of these have you done under local ? My experience is that
> >> they
> >> are at least twice as big as thought and require placement of mesh to
> >> close.
> >> >
> >> > Dan
> >> >
> >> > -----Original Message-----
> >> > From: Gerald P. RodriguezTo: Multiple recipients of list OB-GYN-L
> >> > Sent: 7/30/2002 8:41 AM
> >> > Subject: Re: endometriosis in C/S scar
> >> >
> >> > Yes, she has a chance of having endometriosis in the pelvis,
appendix,
> >> > etc. Since you say she has no other symptoms, I would resect what is
> >> > likely a endometrioma in her C/S scar under local, if the patient is
> >> > amenable to local, and leave well enough alone.
> >> >
> >> > Gerald P. Rodríguez, M.D., FACOG
> >> > Santa Fe
> >> >
>> >> > ----- Original Message -----
> >> > From: Braun, R. Daniel <mailto:rbraun@iupui.edu>
> >> > To: Multiple recipients of list
> >> > <mailto:ob-gyn-l@mail.medispecialty.com> OB-GYN-L
> >> > Sent: Tuesday, July 30, 2002 7:21 AM
> >> > Subject: endometriosis in C/S scar
> >> >
> >
>
