Re: Ob: staples at C/S
From: D. Ashley Hill (dahmd@cfl.rr.com)
Sun Jul 30 14:45:14 2006
It's fascinating to see the variation in techniques from listmembers.
Dr. Potur, why lock the peritoneum? I was taught that locking is for
hemostasis., and the peritoneum rarely bleeds. Although I was trained
to lock the uterine incision, I stopped doing this about 10 years ago
since I suspect it causes tissue necrosis. Since we're on this subject,
can anyone offer a coherent explanation for "tagging" the lateral
uterine (apex) sutures with hemostats while sewing an exteriorized
uterus? Thanks,
Ashley
At Sun, 30 Jul 2006, =?UTF-8?Q?Bülent_Potur?= wrote:
>
>Dear Doctor Siegel,
>I am pleased that my message got a citation. :)
>I think we are discussing the closure of the skin, not a whole procedure.
>Personally I have been closing all the skins with 00 prolene subcuticular
>stitch for the last 5 years. So not one patient had to request me courtously
>to do it this way. And believe me, it is a see one do one and teach one
>experience. About patient hospitalization: Legally we have to keep them one
>week in the hospital after birth or cesarean. The c/s patients usually quit
>the hospital on the second or at most third post operative day by signing
>their file. They do not have to come back to the hospital for removal of
>their sutures. At a village health hearth a nurse cuts one end the suture
>and pulls it out from the other end, the whole suture, in all in one step in
>a second or two on the seventh postoperative day. It does not ache.
>
>For listmates who may have noticed my old messages I must confess that I
>changed what I said there after I started to use Joel Cohen Incision and
>Misgav Ladach Technique. I must also mention Dr. Joane's remarks and last
>years trend and recommendations to close parietal peritoneum.
>What I do now: Uterus corners no 2 chromic, 1 layer No1 vicryl without
>locking, viceral peritoneum 00 continuous locking, parietal peritoneum 00
>chromic continous locking, fascia no2 vicryl continuous, skin 00
>subcuticular prolene continuous. That's all.
>So: Uterus is closed one layer without locking, recti muscles are not
>approximated, subcutaneum is not sutured. After Misgav Ladach I do not
>remember ever putting a knot for a subcutaneous bleeder. An I never use
>cautery in a C/S operation.
>Why I started to leave the skin to the nurses ? Well I observed them and I
>saw that they do it perfectly well. And they want to do it. If they complain
>I may restart any time.
>
>Bulent Potur MD Obgyn
>Kirikkale TURKEY
>
>2006/7/29, Garry E. Siegel, M.D. <garrys@mindspring.com>:
>>
>> an).
>> >
>> >And no, you wouldn't argue with a "professional" about his job, e.g. the
>> >ood
>> >was prepared. So does that make you feel like more of a "server" than a
>> >"professional?" It should.
>> >
>> >And therein lies one of the major problems with medicine today. Patient
>> and
>> >ge
>> >of "client."
>> >
>> >Joe P.
>>
>> I explain my experience to patients and they typically understand. I to
>> have had my midwives comment on this and have had to explain my way out
>> of situations because they have told patients that I do it because it is
>> faster. That is true, but not the reason I do it. Bottom line is there
>> is no difference in the ultimate outcome so you do what you are most
>> comfortable doing, as the surgeon. Can you imagine the cardiovascular
>> surgeons response to somebody telling them how to close a chest... Lynn
>>
>> Bingo, and thanks. I am the patient's (not the husband, thank you
>> Bradley method) physician, not their waiter. I have a greater calling
>> and responsibility than the waiter, or the plumber, with no disrespect
>> to those fine individuals. Obviously, there must be something out there
>> in the circles in which these patients travel, and I bet that the time
>> factor ("the DOCTOR is in a hurry") may be some part of it.
>>
>> Dr. Potur's comment regarding courtesy is important, but I contend
>> that, at the end of the day, a courteous request to do that which you
>> don't think proper (i.e. I want you to use stitches, even though that's
>> not what you're good at) is simply foolhardy and so inappropriate.
>>
>> Yesterday, I did two sections for patients of our CNMs, both of whom
>> asked for stitches, and both of whom got staples.
>>
>> The first, a failed VBAC, when asked why she wanted stitches, said:
>>
>> "Because staples are so impersonal."
>>
>> That was a new one.
>>
>> Garry
>>
>> That said, I wish that the tile man and the plumber would get finished
>> in our bathroom!
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
