B Lynch suture is applied on:
3. Fallopian tubes.
Who knows ??
- The B-Lynch suture, also known as the brace suture, was described by Christopher B Lynch and co-workers in 1997 as an alternative surgical method of controlling postpartum haemorrhage due to uterine atony. The method is simple and seems to be effective, although only case reports are available to evaluate the efficacy of the procedure thus far.
· The technique can be summarised as follows: (see figure 1 in the book)
- General anaesthesia, urinary catheter in place and the patient in the Lloyd Davies position.
- Pfannenstiel incision usually adequate.
- Lower segment uterine incision (as for Caesarean Section) made after dissecting off the bladder.
- Bimanual compression of the uterus to assess the potential chance of success of the B-Lynch suturing technique. If bimanual compression controls the bleeding as observed vaginally, the suture is placed.
- A no.2 chromic suture on a round bodied needle is used to puncture the uterus about 3 cm below the right hand corner of the lower segment incision and brought out about 3 cm above the same corner (as one would place the first suture when closing this corner of the incision).
- From this point the suture is passed over the right hand cornu of the uterus, approximately 3-4cm from the right corneal border, where it may be fixed to prevent it from slipping off the fundus, and then fed posteriorly and vertically down to the same level where the suture has previously left the uterine cavity from anterior.
- The suture is then placed through the posterior uterine wall into the cavity under direct vision of the surgeon and back through the posterior wall about 4-5cm left of the previous entry site.
- With the suture outside and posterior of the uterine cavity at this stage, it is now passed over the left hand cornu, approximate 3-4cm from the left corneal border, where again it may be fixed to the fundus, then fed anteriorly and vertically down to the level of the left corner of the lower segment incision.
- The needle is then passed through the left corner in the same fashion as on the right hand side, to emerge below the incision margin on the left side.
- With the suture now in place, the assistant bimanually compresses the uterus while the surgeon pulls the chromic suture taught.
- If a third person confirms that the bleeding is controlled (as observed vaginally), the surgeon ties the suture to keep it in position and closes the lower segment uterine incision.
Thanks to Dr.Naveen Kansal of Meerut (Author of the book on Q & Ans on PGI Chandigarh Entrance Exam, published by Jaypee brothers) for this text and Diagram
Source of this Question: RxPG AIPG 2004
Author : Dr. J. Mariano Anto Bruno Mascarenhas
Publisher: Jaypee Brothers Medical Publishers, India
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