Re: Catgut
From: art fougner, md (evsono@pipeline.com)
Tue Aug 9 11:52:21 2005
EBM Reviews - Cochrane Central Register of Controlled Trials
Accession Number CN-00469678
Author Kohaut BA, Musselman BL, Sanchez-Ramos L, Kaunitz AM
Institution Department of Obstetrics and Gynecology, University of
Florida Health Science Center/Jacksonville, 3627 University Boulevard
South, Suite #355, Jacksonville, FL 32216, USA.
Title Randomized trial to compare perioperative outcomes of Filshie clip
vs. Pomeroy technique for postpartum and intraoperative cesarean tubal
sterilization: a pilot study.
Source Contraception. 69(4):267-70, 2004 Apr.
Abstract OBJECTIVE: To compare, by conducting a randomized trial,
Filshie clip and Pomeroy techniques for postpartum and intrapartum
cesarean sterilizations in a United States teaching hospital with
respect to surgeon preference and perioperative outcomes. METHOD:
Thirty-two obstetric patients consented for sterilization were
randomized to Pomeroy technique or Filshie clip placement. Following
the surgical procedure, surgeons and operating room technicians
completed a survey regarding their experience with the procedures and
preference. Patient demographic data, time for procedure and follow-up
visits were obtained by chart review. RESULTS: For most postpartum
sterilizations, the mean duration of the procedure was almost 7 min
faster for the Filshie clip technique (p = 0.08); perioperative outcomes
were equivalent (p = 0.05). Application of the Filshie clip was rated
easier than Pomeroy suture application and, overall, the Filshie clip
sterilization procedure was rated less difficult (p = 0.03). Seventy
percent of surgeons preferred the Filshie clip technique and would
choose it if only one postpartum sterilization method was available.
CONCLUSION: For obstetric sterilization, surgeons preferred the Filshie
clip over the Pomeroy technique. In addition, operating time was
shorter for the Filshie clip. This pilot study suggests that use of the
Filshie clip technique has the potential to establish a new standard of
care for postpartum and intrapartum cesarean sterilization.
hope this helps the discussion.
art
At Tue, 9 Aug 2005, ainsron wrote:
>
>No, they have been easy to place, just fan out the tube.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod
>Darryl G MAJ 48 MDOS/SGOBO
>Sent: Tuesday, August 09, 2005 12:03 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Catgut
>
>Hulka clips at c-section? I wonder why that was never taught before? It
>makes perfect sense. Do you think you have any more problems with placement
>because of the size of the tube at delivery?
>
>Glen
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron
>Sent: Monday, August 08, 2005 4:22 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Catgut
>
>I do the same. However, I've quit using the Pomeroy technique for PPTLs and
>TLs at the time of C/S. I now use the Hulka Clips, quick, simple and
>bloodless.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>Ramirez
>Sent: Monday, August 08, 2005 7:59 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Catgut
>
>I also use plain for Pomeroy's -- I don't Vicryl is a good choice for it
>unless one is doing Parkland...
>
>>At Mon, 8 Aug 2005, Charlie Chambers wrote:
>>
>>Yep, plain gut for Pomeroy's. Any modification has merely decreased the
>>efficacy, such as other suture materials, cautery of the cut ends, etc.
>>
>>************************************************************************
>>****
>>************************************************************************
>>************************************************************************
>>
>>--
>>Charlie Chambers
>>Hood River, OR USA
>>cchamber@alumni.rice.edu
>>
>>"...not because I regard fishing as being so terribly
>>important but because I suspect that so many of the other
>>concerns of men are equally unimportant-and not nearly
>>so much fun."
>> John Voelker
>>************************************************************************
>>*****
>>************************************************************************
>>************************************************************************
>>On Aug 8, 2005, at 4:17 AM, Larry Glazerman wrote:
>>
>>> My understanding is that the original work by Pomeroy used the fact
>>> that when catgut was used, the two ends of the tube didn't stay in
>>> approximation for very long, therefore the risk of fistula was
>>> decreased. I can't prove that, but that's why I remember always using
>>> catgut for tubals
>>>
>>> Larry R. Glazerman, MD
>>>
>>> Ob-Gyn at Trexlertown, PC
>>>
>>> 610-402-0161
>>>
>>> l.glazerman@rcn.com
>>>
>>> <unknown.jpg>
>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>> Bernard Cristalli
>>> Sent: Monday, August 08, 2005 2:59 AM
>>> To: Multiple recipients of list OB-GYN-L
>>> Subject: Re: Catgut
>>>
>>> That's gambling.
>>> What you want is temporary TL?
>>> BC
>>>
>>> Elrod Darryl G MAJ 48 MDOS/SGOBO a écrit :
>>>
>>> I only use plain gut for postpartum or c-section tubal ligations. I
>>> can't think of any place else it would benefit.
>>>
>>> Glen
>>>
>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>> Henry 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
>>>>
>>>> <imstp_emo_es.gif>
>>
>--
>"Character may be manifested in the great moments, but it is made in the
>small ones."
>
> - Phillip Brooks
>
> ~walt whitman~
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
