Re: One layer uterine closure
From: Bernard Cristalli (bcrist@club-internet.fr)
Sat Sep 2 09:15:23 2006
Content-Type: text/plain; charset=ISO-8859-1; format=flowed
Content-Transfer-Encoding: 8bit
Catgut (every version) has been withdrawn from the shelves since the BSE
(mad cow disease) here.
Bernard
Garry E. Siegel, M.D. a écrit :
> Dan, as always, you are the man.
>
> I recall a time a few years ago when the one layer closure was touted as
> the latest here in the US, and then a paper came out with a slightly
> higher uterine rupture rate (Gosh, I think we chatted about it here).
>
> I was using a one layer closure on the thin, laboring uterii which lent
> themselves to it. However, on thick, unlaboring uterii, I might do
> two-layers where the inner and outer halves of the myometrium were
> closed separately, which, in essence, is a one-layer.
>
> After the paper, I have stuck with a two-layer; if laboring and thin
> enough, full thickness for the first, locking suture, and then an
> imbricating, locking second layer. If thicker and not amenable to a
> full thickness first layer, well I do as described above.
>
> Suture? #1 Chromic on the larger CTX needle for the first layer, and #1
> Chromic on a CT-1 for the second, as it is more precise and easier for
> me. I used Vicryl years ago (and it comes on both needles, Dan) but it
> always seemed to tear through the tissue more often.
>
> Locking vs. non-locking? Chromic vs. vicryl? Don't we all think that
> there is enough blood flow and that the pregnant uterus is sufficiently
> forgiving such that it probably doesn't matter, as long as you follow
> good technique? That is my supposition.
>
> Garry
>
> At Sat, 2 Sep 2006, R. Daniel Braun wrote:
>
>> I have used #1 chromic because it has a large needle which makes it easier
>> to close the uterus.
>>
>> a
>> lot shorter because the uterus has started to involute. The suture is the
>> same length that it was and is holding no tension on anything and that is
>> true no matter what type of closure one did, except for interrupted.
>>
>> Dan
>>
>> re
>>
>> On 9/2/06, Laure <lfolgar@vianwe.com> wrote:
>>
>>> Most of spanish obstetricians are doing now one continuous layer. For
>>> many years, the standard was; first continuous and second a Lembert-like
>>> discontinuous, teorically to avoid adhesions by eliminate the lesionated
>>> uterus contact peritoneum. There´s no doubt about the elegance of this
>>> procedure, but I´m not sure that avoid adhesions. If you have time is
>>> good for training in surgery to residents, without complications. With
>>> residents, one continuos layer make me more than one problem when i was
>>> call for reoperate a opened uterus who lost a knot.
>>> Althoug in Spain VBAC is always tried.
>>>
>>> Economics are making diference in surgery, are we sure this is the right
>>> way?.
>>>
>>> In Spain, cromic are forbiden by a political decision in the mad cows
>>> disaster.
>>>
>>> -----Mensaje original-----
>>> De: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] En nombre de Dr
>>> Eberhard Lisse
>>> Enviado el: sábado, 02 de septiembre de 2006 8:54
>>> Para: Multiple recipients of list OB-GYN-L
>>> Asunto: Re: One layer uterine closure
>>>
>>> Bernard,
>>>
>>> There is no standard in Europe.
>>>
>>> In Europe there are at least 6 schools of thought that I know personally
>>> of, French, UK, West and East German, Romanian and Russian. And I have
>>> no clue what happens in Spain, Italy and other places.
>>>
>>> The rupture rates have nothing to do with other countries per se, but
>>> perhaps with other techniques.
>>>
>>> I don't think 2 layers is worse than one, takes one minute longer, and
>>> makes me feel better. I *HAVE* seen onlayer closure com eloose once with
>>> catastrophic results.
>>>
>>> el
>>>
>>> on 9/2/06 7:23 AM Bernard Cristalli said the following:
>>>
>>>> One layer closure has been the standard of care here (France, and
>>>> Europe I believe) for the last 40 years. I haven't seen our rupture
>>>> rates at VBAC are higher than others, and we perform a lot of VBACs.
>>>> BC
>>>>
>> --
>> R. Daniel Braun
>>
>> ..
>> Hippocrates
>>
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
|
|
