OB-GYN-L Messages for August, 2005: Re: Catgut

Re: Catgut

From: Peter Wein

pwein@unimelb.edu.au

Tue Aug 9 23:20:54 2005

-- Peter Wein

>----- Original Message ----- From: "Efrain Ramirez" <eramirezt@coqui.net> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Wednesday, August 10, 2005 10:30 AM Subject: Re: Catgut

> CLINICAL MANAGEMENT GUIDELINES FOR > OBSTETRICIAN-GYNECOLOGISTS > NUMBER 46, SEPTEMBER 2003 > > (Replaces Technical Bulletin Number 222, April 1996) > > The CREST data reported that the 10-year cumulative probability for > sterilization failure varied by sterilization method and ranged from 7.5 > per 1,000 to 36 per 1,000 procedures. Postpartum partial salpingectomy > had the lowest 5-year and 10-year cumulative pregnancy rates: 6.3 per > 1,000 and 7.5 per 1,000 procedures, respectively. The 5-year and > 10-year pregnancy rates, respectively, for other occlusion methods are > as follows (43): > > Bipolar coagulation: 16.5 per 1,000 and 24.8 per 1,000 procedures > Silicone band methods: 10 per 1,000 and 17.7 per 1,000 procedures > Spring clip: 31.7 per 1,000 and 36.5 per 1,000 procedures > > Secondary analysis of 5-year failure rates with bipolar coagulation > performed in different decades found that failure was significantly > lower in later periods, reflecting improved technique with the method: > 19.5 per 1,000 procedures for 1978-1982 versus 6.3 per 1,000 procedures > for 1985-1987 (16). The 10-year cumulative risk of pregnancy was > highest among women sterilized at a young age with bipolar coagulation > (54.3/1,000) and clip application (52.1/1,000). The study cautions that > the reported failure rates should not be considered in isolation of > other variables that influence overall outcome. A > > t Tue, 9 Aug 2005, art fougner, md wrote: >> >>According to Cochrane there are no trials large enough to assess. In >>the one trial comparing Fishlie and Pomeroy, there was one pregnancy in >>the Pomeroy group, none in the Fishlie group. However, I will happily >>defer to those with more experience in this area. >> >>art >> >>At Tue, 9 Aug 2005, Efrain Ramirez wrote: >>> >>>I think the Filshie clips have the highest failure rates..?? >>> >>>>At Tue, 9 Aug 2005, art fougner, md wrote: >>>> >>>>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. >>>>>> >>>>>>************************************************************************ >>>>>>**** >>>>>>************************************************************************

>>>>>>************************************************************************ >>>>>>************************************************************************ >>>>>>************************************************************************ >>>>>>************************************************************************ >>>>>>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 �crit : >>>>>>> >>>>>>> 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 >>>> >>>-- >>>"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 >> > > -- > "Character may be manifested in the great moments, but it is made in the > small ones." > > - Phillip Brooks > > ~walt whitman~

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