Re: Single Layer vs Double Layer Uterine Closure
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Nov 5 14:36:50 2003
I do not use locking sutures - 2 rows - (last time in my residency
years)anecdotally - continuous running suture is more hemostatic -
creates better closure - in my hands....
>At Wed, 5 Nov 2003, Braun, R. Daniel wrote:
>
>Locking creates necrosis within the locked area of tissue.
>
>Dan
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>Richard Chudacoff, MD
>Sent: Wednesday, November 05, 2003 9:25 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Single Layer vs Double Layer Uterine Closure
>
>Why would not locking make that much of a difference? I've always locked
>(and I must say, Dan, my numbers are probably far less then yours just
>based on expose to the practice) and have seen my incisions on repeat
>sections that look quite sturdy. Nor am I aware of any of successive
>pregnancies after my c-section that has ruptured. Of course, my case
>list is slightly* less than 10,000.
>
>*-probably less than 1000 as well-not including my Ben Taub experience.
>
>Richard Chudacoff, MD
>
>The more laws, the less justice.
>Marcus Tullius Cicero
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Braun,
>R. Daniel
>Sent: Wednesday, November 05, 2003 7:48 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Single Layer vs Double Layer Uterine Closure
>
>If you all remember, I made a big point out of the fact that in the
>McGill study, all of the single layer closures were running lock
>stitches. This article does not state whether or not the single layers
>were locked. It just says a continuous running suture. I would think
>that they were not locked since it doesn't specify, but you know what
>assuming does. I have closed mine with a running NON locked single layer
>of Number 1 chromic catgut for a long time. I really think that not
>locking makes a big difference.
>
>Dan
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>fougner, md
>Sent: Tuesday, November 04, 2003 12:46 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: OB: Single Layer vs Double Layer Uterine Closure
>
>This was kicked around awhile ago - here's more fuel to the fire - this
>from the October Gray Journal.
>
>Uterine rupture, perioperative and perinatal morbidity after
>single-layer and double-layer closure at cesarean delivery
>
>Celeste Durnwald, MD [MEDLINE LOOKUP]
>Brian Mercer, MD [MEDLINE LOOKUP]
>
> Abstract
>
>Objective This study was undertaken to evaluate the risks and benefits
>of single-layer uterine closure at cesarean delivery on the index and
>subsequent pregnancy.
>
>Study design A retrospective study of women delivered of their first
>live-born infants by primary low transverse cesarean delivery
>(1989-2001) and their subsequent pregnancy at our institution was
>performed.
>
>Results Of 768 women studied, 267 had single-layer and 501 had
>double-layer uterine closures in the index pregnancy. Single-layer
>closure was associated with slightly decreased blood loss (646 vs 690
>mL, P<.01), operative time (46 vs 52 minutes, P<.001), endometritis
>(13.5% vs 25.5%, P<.001), and postoperative stay (3.5 vs 4.1 days,
>P<.001). In the second pregnancy, prior single-layer closure was not
>associated with uterine rupture after a trial of labor (0% vs 1.2%,
>P=.30), or other maternal or infant morbidities. Prior single-layer
>closure was associated with increased uterine windows (3.5% vs 0.7%,
>P=.046) at subsequent cesarean delivery.
>
>Conclusion Single-layer uterine closure is associated with decreased
>infectious morbidity in the index surgery, but not uterine rupture or
>other adverse outcomes in the subsequent gestation
>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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