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Re: GYN: Contemporary Management of Pelvic Relaxation From: John Robertson M.D. (john.robertson@obgyn.net) Tue Oct 26 14:14:33 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Rafael Haciski MD: "Re: me" Previous message: Rafael Haciski MD: "Re: Free Electronic Chart Program for Ob/Gyns" In reply to: Garry E. Siegel, M.D.: "GYN: Contemporary Management of Pelvic Relaxation" At Mon, 25 Oct 1999, Garry E. Siegel, M.D. wrote: > >In this month's 10th anniversary issue of OB-GYN Management, one writer >reflects on a decade of change in patient care with respect to pelvic >reconstruction. His example is a 64 YO with a "bulge," SUI, and on exam >she has a procidentia. He comments that the repair in 1989 would have >been a TVH, BSO if accessible, McCall's culdoplasty, and A and P repair. > >In 1999, she would have a TVH, BSO (new technique with an endoloop that >gets the ovaries), Why do you need endoloops to do this? Are they talking about doing it laparoscopically from above first? Taking out ovaries from below is often easy to achieve, and I do not see what an endoloop would add. and then a "complete assessment of the pubocervical >fascia would be made." Yada yada polybutester suture would be used, >cystoscopy done, fix posterior and lateral fascial tears. This >operation would restore normal anatomic landmarks that determine vaginal >length and axis. Yeah right! Just like a Netter (sp?) diagram. Who is this guy? "No longer are rapidly absorbable sutures used to fold >the bladder wall in a futile attempt to use a distensible organ as its >own support.. . Plication of the levator muscles is no longer an >accepted practice." Somewhere else, he (or someone else) says that all >of this isn't accessible by the lapscope. > >I'm feeling a bit out of the loop here. What think you? > >Garry You're not the one out of the loop. > >-- >Garry E. Siegel, M.D., FACOG >Private Practice >Roswell, Ga. > John -- J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9, Canada (604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV Next message: Rafael Haciski MD: "Re: me" Previous message: Rafael Haciski MD: "Re: Free Electronic Chart Program for Ob/Gyns" In reply to: Garry E. Siegel, M.D.: "GYN: Contemporary Management of Pelvic Relaxation"

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