The most basic operative procedure performed by a junior resident doctor in Obstetrics is episiotomy and its suturing. I had made a few and sutured them as an intern too. There would not be any controversy about it, one would think. Well, one can often be wrong. I was conducting viva for undergraduate students. I asked a question on episiotomy and the controversy came to light.
"The muscle layer of the episiotomy is sutured with figure-of-eight sutures of absorbable material" he said. I visualized the poor muscles of the woman's perineum being strangulated by the sutures and winced.
"Figure-of-eight?"
"Yes, sir. That is how I have seen it being done in 12 cases when I worked in the labor ward. I sutured three myself the same way." He must have been telling the truth, I realized. I let him go, and called a couple of resident doctors I spotted in the ward. I asked them the same question and they gave the same answer. That got me worried. Simple sutures was what I had read as a student and practiced as a doctor.I spotted an Associate Professor, and mustered up courage to ask that question.
"Figure-of-eight."
I was aghast. Then I conducted a survey of all staff members and resident doctors who were willing to participate. A few Assistant professors put figure-of-eight sutures, a lot more resident doctors did so, and all others put simple sutures. I even asked a resident doctor who had passed out recently and was working in another institute.
"Figure-of-eight. "
"Does it not cut off the blood supply of the muscle and cause its necrosis? What did you read in Williams' Obstetrics?" I asked him.
"Sir, the 23rd edition of Williams says simple sutures or continuous noninterlocking sutures achieve the same result. But I put figure-of-eight sutures. Now I will switch to simple sutures."
The following graph shows distribution of doctors who used the two types of the sutures. SI is short for 'simple interrupted' and FOE is short for 'figure-of eight'.
I checked Williams' Obstetrics. The 22nd edition put simple sutures in the muscle, while the 23rd edition did say simple or continuous sutures could be put. I wonder why those obstetricians saw any need to try out a continuous suture, when it is known fact that nowhere else in the body the muscle is sutured that way, how they got institutional ethics committee's permission to do so, and what the achieved by that. I must admire the spirit of the doctors who have independent minds, who put sutures of their choice, instead of doing what is taught by their teachers or what is written in books. I will continue to put simple sutures myself.
"The muscle layer of the episiotomy is sutured with figure-of-eight sutures of absorbable material" he said. I visualized the poor muscles of the woman's perineum being strangulated by the sutures and winced.
"Figure-of-eight?"
"Yes, sir. That is how I have seen it being done in 12 cases when I worked in the labor ward. I sutured three myself the same way." He must have been telling the truth, I realized. I let him go, and called a couple of resident doctors I spotted in the ward. I asked them the same question and they gave the same answer. That got me worried. Simple sutures was what I had read as a student and practiced as a doctor.I spotted an Associate Professor, and mustered up courage to ask that question.
"Figure-of-eight."
I was aghast. Then I conducted a survey of all staff members and resident doctors who were willing to participate. A few Assistant professors put figure-of-eight sutures, a lot more resident doctors did so, and all others put simple sutures. I even asked a resident doctor who had passed out recently and was working in another institute.
"Figure-of-eight. "
"Does it not cut off the blood supply of the muscle and cause its necrosis? What did you read in Williams' Obstetrics?" I asked him.
"Sir, the 23rd edition of Williams says simple sutures or continuous noninterlocking sutures achieve the same result. But I put figure-of-eight sutures. Now I will switch to simple sutures."
The following graph shows distribution of doctors who used the two types of the sutures. SI is short for 'simple interrupted' and FOE is short for 'figure-of eight'.
I checked Williams' Obstetrics. The 22nd edition put simple sutures in the muscle, while the 23rd edition did say simple or continuous sutures could be put. I wonder why those obstetricians saw any need to try out a continuous suture, when it is known fact that nowhere else in the body the muscle is sutured that way, how they got institutional ethics committee's permission to do so, and what the achieved by that. I must admire the spirit of the doctors who have independent minds, who put sutures of their choice, instead of doing what is taught by their teachers or what is written in books. I will continue to put simple sutures myself.
