Re: One layer uterine closure
From: Bernard Cristalli (bcrist@club-internet.fr)
Fri Sep 8 00:46:27 2006
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Observational study, and one layer sutures done by people used to suture
in 2 layers, one can wonder if they do it right.
BC
Efrain Ramirez a écrit :
> At Thu, 7 Sep 2006, R. Daniel Braun wrote:
>
>> OOOOOOOOHHHH!!!!!!!!!!!
>> Data???
>>
>> Dan
>>
> The impact of a single-layer or double-layer closure on uterine rupture.
> Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ
>
> Am J Obstet Gynecol (2002 Jun) 186(6):1326-30 ISSN: 0002-9378
>
> Obstetric Surgical Procedures
> Uterine Rupture
> Cohort Studies
> Comparative Study
> Female
> Human
> Odds Ratio
> Pregnancy
> Recurrence
> Trial of Labor
>
> Abstract
>
> OBJECTIVE: Our purpose was to measure the impact of a single-layer or
> double-layer closure on uterine rupture at subsequent delivery.
>
> STUDY DESIGN: This is an observational cohort study of all women
> undergoing a trial of labor from 1988 to 2000 in a tertiary care center,
> after a single low transverse cesarean delivery. Factors most highly
> associated with uterine rupture were identified by using univariate
> regression analysis. Multivariate logistic regression analysis was used
> to adjust for selected confounding variables.
> Top of Abstract
> RESULTS: Of the 2142 women who met the study criteria, 1980 (92.4%) had
> maternal records and original operative reports reviewed. After
> adjustments were made for confounding variables, the odds ratio for
> uterine rupture in women with a single-layer closure was 3.95 (95% CI,
> 1.35- 11.49).
>
> CONCLUSION: A single-layer closure of the previous lower segment
> incision was the most influential factor and was associated with a
> 4-fold increase in the risk of uterine rupture compared with a
> double-layer closure.
>
>> On 9/6/06, Efrain Ramirez <eramirezt@coqui.net> wrote:
>>
>>> Discussed before in this forum before - 2 rows better than one ..
>>>
>>> Ef
>>>
>>>> At Wed, 6 Sep 2006, R. Daniel Braun wrote:
>>>>
>>>> Much longer than is needed with a uterine scar at C/S
>>>>
>>>> On 9/6/06, ainsron <ainsron@sbcglobal.net> wrote:
>>>>
>>>>> There is a graph on the previously quoted page in Telinde that shows
>>>>>
>>> the
>>>
>>>>> tensile strength of chromic catgut falling to 60% at one week, 40% at 2
>>>>> weeks and 0% four weeks and complete absorption by 90 days. The data
>>>>>
>>> is
>>>
>>>>> based on Ethicon Research and compares it to plain gut, dexon, vicryl,
>>>>> maxon
>>>>> and PDS.
>>>>>
>>>>> Ronald E. Ainsworth, MD, FACOG
>>>>>
>>>>> -----Original Message-----
>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
>>>>>
>>> E.
>>>
>>>>> Siegel, M.D.
>>>>> Sent: Tuesday, September 05, 2006 6:46 PM
>>>>> To: Multiple recipients of list OB-GYN-L
>>>>> Subject: Re: One layer uterine closure
>>>>>
>>>>> I just looked at info on Monocryl and Coated Vicryl on Ethicon's site.
>>>>>
>>>>> Monocryl is absorbed in 90 to 119 days, and has 30 to 40% of its
>>>>>
>>> tensile
>>>
>>>>> strength at 2 weeks.
>>>>>
>>>>> Coated Vicry is absorbed in 56 to 70 days, and has75% of its tensile
>>>>> strength at 2 weeks, and 25% at 4 weeks.
>>>>>
>>>>> I could not find similar data for Chromic, and it is an Ethicon
>>>>>
>>> product.
>>>
>>>>> Garry
>>>>>
>>>>> At Wed, 6 Sep 2006, Raymond Stephen wrote:
>>>>>
>>>>>> Not wishing to start a war, but I'm afraid Telinde is wrong. Chromic
>>>>>> catgut loses its strength inside ten days as against Vicryl which has
>>>>>>
>>> a
>>>
>>>>>> minimum of three weeks and often up to six. The increased tissue
>>>>>> reaction is however, correct. Christopher is also wrong to say it
>>>>>>
>>> takes
>>>
>>>>>> 70 days to absorb plain catgut. It is unusual to see it persist
>>>>>>
>>> beyond
>>>
>>>>>> 7 days!
>>>>>>
>>>>>> Steve
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>>>> Atkinson, Samuel M
>>>>>> Sent: Tuesday, September 05, 2006 7:53 AM
>>>>>> To: Multiple recipients of list OB-GYN-L
>>>>>> Subject: Re: One layer uterine closure
>>>>>>
>>>>>> We have previously been thru this subject. According to Christopher's
>>>>>> Text of Surgery, there is no place for the use of catgut in the
>>>>>>
>>> human.
>>>
>>>>>> This is because of its' enormous inflammatory response. Plain catgut
>>>>>>
>>> is
>>>
>>>>>> totally absorbed in 70 days at the expense of the most significant
>>>>>> inflammatory reaction. This is why we are foolish to use plain gut
>>>>>>
>>> for
>>>
>>>>>> reperitonealization. Chromic has essentially the same absorption
>>>>>>
>>> pattern
>>>
>>>>>> as polyglycolic (read vicryl/monocryl) but with a significant tissue
>>>>>> reaction. Tensile strength, however lasts longer.
>>>>>> To again quote the latest edition of Telinde, Seventh Edition. p.232,
>>>>>> "...Catgut should not be routinely used in gynecologic surgery.
>>>>>>
>>> Indeed,
>>>
>>>>>> there remains little indication for the use of catgut in any
>>>>>>
>>> gynecologic
>>>
>>>>>> procedure."
>>>>>> sAm
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>>>> Raymond Stephen
>>>>>> Sent: Monday, September 04, 2006 7:26 PM
>>>>>> To: Multiple recipients of list OB-GYN-L
>>>>>> Subject: Re: One layer uterine closure
>>>>>>
>>>>>> 1. Catgut is absorbed faster - often an advantage.
>>>>>> 2. Catgut is somewhat stiffer so it stands up when you are trying to
>>>>>> find an end to tie.
>>>>>> 3. Catgut is somewhat smoother than Vicryl
>>>>>>
>>>>>> These are reasons to use catgut. That doesn't mean I don't like
>>>>>>
>>> Vicryl
>>>
>>>>>> but it has its place.
>>>>>>
>>>>>> Steve
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr
>>>>>> Eberhard Lisse
>>>>>> Sent: Monday, 4 September 2006 2:23 PM
>>>>>> To: Multiple recipients of list OB-GYN-L
>>>>>> Subject: Re: One layer uterine closure
>>>>>>
>>>>>> Art,
>>>>>>
>>>>>> I don|t know. But what I know, is that the US government was quite
>>>>>>
>>> ready
>>>
>>>>>> to ban blood donors if they just set foot down in Europe.
>>>>>>
>>>>>> What I also know is that (bio-)chemistry doesn't lie.
>>>>>>
>>>>>> And, when paying attention a bit, I usually don't tear it through the
>>>>>> muscle.
>>>>>>
>>>>>> So, why use catgut (and/or chromic)?
>>>>>>
>>>>>> el
>>>>>>
>>>>>> --
>>>>>> Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>>>>> el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>>>>> PO Box 8421 \ / Please send DNS/NA-NiC related e-mail
>>>>>> Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na
>>>>>>
>>>>> --
>>>>> Garry E. Siegel, M.D.
>>>>> Private Practice
>>>>> Roswell, GA
>>>>>
>>>> --
>>>> R. Daniel Braun
>>>>
>>>> "The way to health is an aromatic bath and scented massage
>>>>
>>> everyday".
>>>
>>>> Hippocrates
>>>>
>>> --
>>> " The greatest obstacle to knowledge is not ignorance,
>>> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>>>
>> --
>> R. Daniel Braun
>>
>> "The way to health is an aromatic bath and scented massage everyday".
>> Hippocrates
>>
>
> --
> " The greatest obstacle to knowledge is not ignorance,
> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
