Re: One layer uterine closure
From: Henry Gregor (henrygregor@yahoo.com)
Sat Sep 2 22:15:58 2006
Not to flame anyone with this response, but good grief "...prefer time houred..." and "Even the SPCAs ...protect...patinets." ???? Just a touch of scorn, perhaps?
Are you trying to equate time honoured as equal to ethically approved research or postulate its superiority to newer technique on some sort of seniority system? Wasn't bloodletting the time honored technique at one time? Are all the other corrpespondents thoughtless with regard to their patients? Seems like you're implying they are. Seems to me their views are worth respecting, even if one disagrees.
Hank
Kokumo Oyakhire <koyakhire@yahoo.co.uk> wrote:
My patients and I would prefer the time honoured two layered unlocked closure. I do not mind change(s), but any change in practice should have gone through ethically approved researches, at least controlled trials. Even the SPCAs still protect there patients.
"D. Ashley Hill" <dahmd@cfl.rr.com> wrote: Heresy. Actually, I have not locked uterine incisions for over 12 years
(you have me beat by a long shot) due to concerns about tissue necrosis.
Everyone asks "what about hemostasis." If you observe the tissue after
you have completed with your incision line it's obvious if it's bleeding
or not (usually not). What's equally interesting to me is the variety
of suture material. I know someone who uses 3-0 vicryl for the uterus,
whereas I use 0-chromic. I guess we're all victims of our training.
Ashley
At Fri, 1 Sep 2006, R. Daniel Braun wrote:
>
>One needs to ask are these ONE layer LOCKING sutures or one layer NO-LOCKING
>sutures?
>I bet the bad results were with locking and the good ones with non-locking.
>
>Just my opinion and over 40 years observation.
>
>Dan
>
>On 9/1/06, Dr. Cesar Molina wrote:
>>
>> I am a obstetric and gynecologyc surgeon in Costa Rica and have two
>> experiences with one layer uterine closure. For differente
>> circumstances I have to open this patients 7 and 8 days after the
>> section. It was very impressionant the irregular and bad aspect of
>> uterine scarr healing in two cases. Although the inmediate evolution
>> of the patients was good after reintervention(late evolution I don`t
>> know), I felt very much concerned about the future evolution of their
>> abdominal cavities. My impression was that this two patiens will
>> depelop an important adherential syndrome. What is your experience
>> about??
>>
>> At Sun, 10 Jun 2001, art fougner, md wrote:
>> >
>> >germans had an entirely different experience -
>> >
>> >1: Zentralbl Gynakol 1986;108(17):1039-45
>> >
>> >[Clinical experiences with a single layer uterine suture in cesarean
>> >section].
>> >
>> >[Article in German]
>> >
>> >Winkler M, Ruckhaberle KE, Saul S, Forberg J.
>> >
>> >In this analysis 536 caesarean sections with a single layer uterine
>> >suture were compared to 256 sections with two layer closure. Their
>> >relations with regard to indications of operative delivery,
>> >complications during the puerperium and their courses in subsequent
>> >vaginal deliveries were taken into consideration. - The significant
>> >lower rate of pyrexia and shorter hospital stay of the patients may be a
>> >result of quicker and better healing of the single layer suture. The
>> >increased rate of complications in the puerperium is partially due to
>> >changes in the registry of dates. Absent disturbances during the
>> >placental period and the occurrence of only one uterine rupture, in the
>> >course of vaginal delivery in a patient with a previous single layer
>> >caesarean section suture, demonstrates the functional sufficiency of
>> >this technic.
>> >
>> >PMID: 3538711 [PubMed - indexed for MEDLINE]
>> >
>> >seems reasonable to perform a formal trial.
>> >
>> >art
>> >
>> >At Sun, 10 Jun 2001, Steve Raymond wrote:
>> >>
>> >>Yes, and we are considering enrolling, but we had an experience about
>> four years
>> >>ago when one of the rural hospitals that refers to us decided to start
>> one layer
>> >>closures after reading about the Misgav-Ladach technique. We found after
>> a few
>> >>months that they were suddenly sending us problem cases of bleeding and
>> failure
>> >>of healing and such like, which had us mystified until they informed us
>> of the
>> >>change in technique, of which we had not previously been aware.
>> >>
>> >>Seems to me that they should have an ethical committee ruling on this!
>> >>stray
>> >>
>> >>> The CAESAR study is recruiting in UK, is it not?
>> >>>
>> >>> Rupak Ranjan Roy
>> >>> MRCOG
>> >>
>> >>--
>> >>
>> >>Dr.S.H. Raymond
>> >>Head of Department of O & G
>> >>Empangeni Hospital
>> >>South Africa 3880
>> >>Phone: (+27) 35-7721111
>> >>Fax: (+27) 35-7922596
>> >>
>> >--
>> >art fougner, md
>> >
>> >A series of 1000 cases begins with but a single anecdote.
>> >
>>
>--
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage everyday".
> Hippocrates
>
--
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
