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Re: misgav ladach methodFrom: Jane Helwig, MD (jane@seasonedsystems.com)Wed Feb 24 18:54:43 1999
This method seems very similar to that described by Marco Pelosi in a Contemporary OB-GYN article in 1995. He did not do Joel Cohen, but used a Bovie to open the subcutaneous tissue as well as the fascia. As is Misgav Ladach, no dissection of the fascia off the rectus muscles, just bluntly separate rectus muscles, bluntly open and extend the peritoneal incision. No bladder flap--make the uterine incision above the reflection of the bladder peritoneum and extending incision bluntly or sharply. No exteriorization of uterus. One-layer uterine closure. No closure of peritoneum. I hope I'm getting all this right as my copy of the article is at the office. I have used the Pelosi technique (except for opening the subcu with the Bovie--I go down to the fascia in the midline sharply and then open subcu bluntly) for the last couple of years with excellent results. No randomized controlled trials yet, but subjectively patients who don't have the fascia dissected off the rectus muscles seem to recover faster than those who don't. I can't think of any reason to do it in primary sections. All this blunt dissection would horrify the gyn oncs who taught me that surgeons use instruments and not fingers to operate, but it seems to work just as well if not better for this purpose. Dr. Pelosi cited an average time around 15 minutes. It takes me longer but I do subcuticular skin suture.
-- Jane Helwig, MD Private practice Nassawadox, VA
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