Re: Ob: staples at C/S
From: Myer Bornstein (mborn@massmed.org)
Sun Jul 30 15:38:19 2006
Tagging is habit no explanation
Myer
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of D.
> Ashley Hill
> Sent: Sunday, July 30, 2006 3:47 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Ob: staples at C/S
>
> 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
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