Mechanical bowel prep
From: rmodugno@aol.com
Wed Jul 30 18:26:51 2008
Interesting article on mechanical bowel prep from the SAMJ
http://www.samj.org.za/index.php/samj/article/viewFile/129/323
Robert Modugno MD
Sylva, NC
>From RModugno@aol.com Wed Jul 30 18:46:40 2008
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To: ob-gyn-l@obgyn.net
Subject: Re: type of incision?
Date: Wed, 30 Jul 2008 19:46:07 -0400
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-----Original Message-----
From: Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au>
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
Sent: Tue, 29 Jul 2008 9:35 am
Subject: Re: OB didelphyic/bicornuate and breech --> type of incision?
The best approach in an obese patient in
obstetrics is the one that allows you to do what you have to do without
postoperative risks. In my view that means avoiding a midline, because
you only need access to the lower segment and sufficient width to
deliver the
baby.
If you need greater access than that, such
as in a placenta percreta where you will probably need access to the
upper
segment, then you have to accept second best and do your midline.
I too close midlines with a “loop
nylon or PDS” and hope and pray that they don’t get infected –
terrible situation if the patient is obese and/or diabetic!
Steve Raymond
Ph (03)62227898
Cell 0438372395
--
=================================
Steve, I know physicians who use the same suture for transverse
incisons and these patient types get infected no matter the abdominal
approach.
What is your approach to the obese patient with a large
pannus/panniculus?
Robert Modugno MD MBA FACOG
Sylva, NC
>From stephen.raymond@dhhs.tas.gov.au Wed Jul 30 19:44:16 2008
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Subject: Re: type of incision?
Date: Thu, 31 Jul 2008 10:44:04 +1000
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From: "Raymond Stephen" <Stephen.Raymond@dhhs.tas.gov.au>
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Start with some Trendelenburg (head down tilt). Perform a transverse incision just above the fold where the pannus reaches the mons. Make the rectus sheath incision wider than usual to compensate for the depth of the fat. Keep a heavy tissue forceps on the upper edge of rectus sheath and fix it in some way to retract constantly throughout the operation.
Infection incidence is probably no different between midlines and transverses, but the potential consequences in a midline are much worse. I know of no evidence that proves that prophylactic antibiotics prevent wound infection, but it is likely. I don't think suture material has any bearing. Attention to minimising tissue trauma, bleeding, haematoma formation and tight bulky suturing are all good strategies.
Steve Raymond
Ph (03)62227898
Cell 0438372395
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of rmodugno@aol.com
Sent: Thursday, 31 July 2008 9:49 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: type of incision?
-----Original Message-----
From: Raymond Stephen <Stephen.Raymond@dhhs.tas.gov.au>
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
Sent: Tue, 29 Jul 2008 9:35 am
Subject: Re: OB didelphyic/bicornuate and breech --> type of incision?
The best approach in an obese patient in
obstetrics is the one that allows you to do what you have to do without
postoperative risks. In my view that means avoiding a midline, because
you only need access to the lower segment and sufficient width to
deliver the
baby.
Steve Raymond
Ph (03)62227898
Cell 0438372395
--
=================================
Steve, I know physicians who use the same suture for transverse
incisons and these patient types get infected no matter the abdominal
approach.
What is your approach to the obese patient with a large
pannus/panniculus?
Robert Modugno MD MBA FACOG
Sylva, NC
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