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Re: Post Partum BTLFrom: MP3 (marcop@agoron.net)Wed Feb 28 06:41:47 2007
Richard Kaplan wrote: > About 6 months ago I had to abandon a post partum BTL on an obese > patient who was close to 36 hours post delivery because her fundus had > involuted to the point where I could not palpate it or find the tubes > through my subumbilical minilap incision. This morning I cancelled a > BTL on another obese patient 24 hours post partum when her fundus > palpated well below the umbilicus (14-16 wks.) and I was afraid that I > would have the same problem. She was happy to schedule a laparscopic > procedure in 5 weeks. My partners think I'm a woos. Have any of you > had similar experiences? > > Richard Kaplan > I've never been an afficionado of the postpartum tubal because of the unnecessary haste associated with a totally elective non-emergent procedure, but I've always kept an operative laparoscope on my set for the rare situation where exposure of the tube was an issue. Also, you'd be better off using a vertical intraumbilical incision in an obese patient because there's much less subcutaneous fat at the umbilicus and you can extend the incision to about 3cm if necessary without a conspicous scar.
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