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Re: "No rectus" From: J. Bulley (jbulley@cheshire.net) Fri Aug 15 20:56:31 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kenneth J. Moise: "Amnioinfusion" Previous message: Dr. Joe Max Mongelli: "Re: OB-GYN-L digest 1158" Next in thread: Garry E. Siegel, M.D.: "(no subject)" Reply: Garry E. Siegel, M.D.: "(no subject)" Malcolm - as I read this I had a recollection of an incision with an eponym wher you start like our usual pfannenstiel but rseparate the rectus from the pubis and reflect it cephalad. (I usually can't remember names!) My TeLinde's happened to be nearby: my recollection was correct! The incision is called the Cherney incision. "Historically, only the Cherney transverse suprapubic incision has been used with any frequency in gynecologic surgery. Although it is one of the strongest of all transverse incisions, excising and replacing the inferior aspect of the rectus muscles fron the superior rami of the pubis is time consuming. Further the epigastric artery and vein are frequently injured and must be ligated and excised to permit upward reflexion and mobility of the rectus muscles for adequate exposure of the pelvis." Sounds like this was a Cherney, but the rectus didn't get put back or stay attached to the pubis. Joanne Bulley MD New Hampshire > >Date: Fri, 15 Aug 1997 21:32:02 +0100 >From: Malcolm Griffiths <Malcolm@mgriff22.demon.co.uk> >To: ob-gyn-l@obgyn.net >Subject: Muscle splitting/mobilising incisions >Message-ID: <W2wPeIACzL9zEwM9@mgriff22.demon.co.uk> > >I did a emeregency CS today on a woman who was in her second pregnancy. >She had previously had priamry infertility. I don't know thje details >but she had tubal surgery under a colleague in London, who is known to >use a transverse abdo incision during which he either divides the rectus >muscle transversely or strips it off the pubic bone. This is supposed to >allow better access. > >Anyway the tuabl surgery wasn't a great success, but she then had IVF >which was successful and resulterd in a singleton normal vaginal >delivery. > >Next time she manages to concived spontaneously !!! > >She has a normal pregnancy and is regularly checked by her midwife and >FP (OK this is UK) and they find pp to be cephalic and at last visit >head is well engaged. > >This morning at 07.30 she comes in established labour with spont ROM, >meconium, difficult to record CTG and confirmed transverse lie, high >pres part on ve, with cervix 1cm dilated. She is 5'9" tall, not obese >and with no previous (other) surgery. > >I decide to do CS !!! > >I use trans abdo incn and aim for LSCS. > >At op there is no rectus muscle !!! !!! > >I go through sheath and find it adherent to peritoneum without any >intervening muscle. I then go one to complete delivery through a poorly >formed thick conical lower segment. Baby is fine. > >Questions: > >1) Anyone come across this incision for tubal surgery ? > >2) Does anyone think that doing such an incision may lead to rectus >problems ? > >3) Was the rectus deficiency yhr cause for transeverse lie ??? >Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt >Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. >Tel: 01582-497459 (office) Fax: 01582-497424 > 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk >http://www.obgyn.net/board/griffith.htm >"It is dangerous to be right on a subject on which the established authorities > >are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths) Next message: Kenneth J. Moise: "Amnioinfusion" Previous message: Dr. Joe Max Mongelli: "Re: OB-GYN-L digest 1158" Next in thread: Garry E. Siegel, M.D.: "(no subject)" Reply: Garry E. Siegel, M.D.: "(no subject)"

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