Reply

Abstract

To the Editors:We thank Escamilla for his kind words and interest in our article. His proposal that a minilaparotomy be defined by the length of the fascial incision is interesting. On the basis of his clinical experience, he believes that this is more applicable to patient outcomes. We do not have experience with Escamilla’s “funnel-like incision,” and it would be difficult to measure our extended fascial incision. I do think that Escamilla has a valid clinical point in that recovery may correlate better with the size of the fascial and peritoneal incisions than with the skin incision. This may explain why we had a difficult time discharging patients before day 3. Our small skin incisions were quite cosmetic, and the patients did seem to appreciate that.We continue to use chromic catgut sutures during hysterectomy for the same reason stated by Escamilla. This seems to be especially true in the teaching setting. The delayed absorbable suture is used on the vaginal cuff in an effort to reduce the formation of granulation tissue. Again, we thank Escamilla for his comments and urge him to report his experience with the “funnel-like incision.”6/8/100638 To the Editors:We thank Escamilla for his kind words and interest in our article. His proposal that a minilaparotomy be defined by the length of the fascial incision is interesting. On the basis of his clinical experience, he believes that this is more applicable to patient outcomes. We do not have experience with Escamilla’s “funnel-like incision,” and it would be difficult to measure our extended fascial incision. I do think that Escamilla has a valid clinical point in that recovery may correlate better with the size of the fascial and peritoneal incisions than with the skin incision. This may explain why we had a difficult time discharging patients before day 3. Our small skin incisions were quite cosmetic, and the patients did seem to appreciate that.We continue to use chromic catgut sutures during hysterectomy for the same reason stated by Escamilla. This seems to be especially true in the teaching setting. The delayed absorbable suture is used on the vaginal cuff in an effort to reduce the formation of granulation tissue. Again, we thank Escamilla for his comments and urge him to report his experience with the “funnel-like incision.”6/8/100638 We thank Escamilla for his kind words and interest in our article. His proposal that a minilaparotomy be defined by the length of the fascial incision is interesting. On the basis of his clinical experience, he believes that this is more applicable to patient outcomes. We do not have experience with Escamilla’s “funnel-like incision,” and it would be difficult to measure our extended fascial incision. I do think that Escamilla has a valid clinical point in that recovery may correlate better with the size of the fascial and peritoneal incisions than with the skin incision. This may explain why we had a difficult time discharging patients before day 3. Our small skin incisions were quite cosmetic, and the patients did seem to appreciate that. We continue to use chromic catgut sutures during hysterectomy for the same reason stated by Escamilla. This seems to be especially true in the teaching setting. The delayed absorbable suture is used on the vaginal cuff in an effort to reduce the formation of granulation tissue. Again, we thank Escamilla for his comments and urge him to report his experience with the “funnel-like incision.” 6/8/100638