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Gregor
Sent: Friday, August 05, 2005 8:38 PM
To: Multiple recipients of list OB-GYN-L
Subject: Catgut
Good - very good - observations by Sam. Prompts the additional question
of is there a desirable time/place/procedure in any surgery for which
catgut would be a preferred suture? Probably not, I suspect but all
thoughts welcome.
Hank Gregor
"Atkinson, Samuel M" <ATKINSONS@mail.ecu.edu> wrote:
You will find the complete reference on the subject in the
August issue of Obstetrics and Gynecology (The Green Journal on page
275.)
Reference 6 is the article by Tulandi et al from Montreal
published in 1988 in AJOG stated that there were more adhesions when the
peritoneum was closed. In a recent publication letter to the editor
they again referenced their article which, evidently very few people
ever read. NO WONDER . They closed the peritoneum with PLAIN CATGUT-the
most inflammatory suture one can use. To quote Michelle Duchinski in
TeLinde "...disadvantages include intense inflammatory scarring .."
"Catgut should not be routinely used in gynecologic surgery. Indeed
there remains little indication for the use of catgut in any gynecologic
surgical procedure." P 232, seventh edition. No wonder they found more
adhesions in reperitonealized patients. Two horrible wrongs do not
equal a right. At last, a level II data paper putting an end to this
BS.
I suspect our other subscriber who entered the bladder -when
she looks up the previous OP note-will find that the peritoneum was not
closed-thus the bladder was adherent to the ant abdominal wall and no
way could one avoid a bladder entry.
By using a monofilament, poly gycolic fine suture and not
pulling the peritoneum up tight into a water tight seal, as many of us
were taught in the dark ages, there will be significantly less adhesions
than if one leaves the peritoneum open. Loosely approximate with non
braided polyglycolic suture.
Sam Atkinson
________________________________
________________________________
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf
Of Julio Arellano
Sent: Monday, August 01, 2005 10:39 PM
To: Multiple recipients of list OB-GYN-L
Subject: New paper - Peritoneum closure
Dear colleagues:
A new outlook on parietal peritoneum closure in c-section:
http://www.pslgroup.com/dg/251a56.htm
I'd like to know your opinion on this matter (here, in my country, we
still discuss about it).
Julio C. Arellano
La Plata. Buenos Aires.
Argentina.
arellano@netverk.com.ar
"Good judgment comes from experience, and often experience comes from
bad judgment."
Rita Mae Brown
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