Re: Ob: staples at C/S
From: Joe (forcep@intercom.net)
Sun Jul 30 16:45:36 2006
Ashley: ref tagging of the incision. Always thought that a waste of time
and effort . Maybe some used for traction. Joe C
D. Ashley Hill wrote:
> 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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