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Re: endometriosis in C/S scarFrom: DoctorJoe@aol.comTue Jul 30 20:02:56 2002
In a message dated 7/30/02 4:28:28 PM, geraldpr@cybermesa.com writes: << 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. >> I would agree, but look at what part of the anatomy you're talking about. Sit back and envision a parous woman's abdomen, in the area of a transverse C-section scar. Go ahead, visualize... NOW, envision what part of the abdomen would be resected in a modified (minor) "tummy tuck." Generally, with a modest scar revision or mini-lipectomy, you don't need any mesh or anything. The redundancy of the tissue there, after a couple of pregnancies, is impressive. Now overlap those two scenarios... Viola! (Right, Bernard?) Joe P.
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