124: Laparoscopic Removal of Sacrocolpopexy Mesh After Failed Conservative Management

Oral Presentations surgeon compared with the previous 39 ASCP by the same surgeon. Intervention: The six principals of cost-effectiveness analysis were used. Patient demographics and outcomes, total direct hospital, direct operating room, and direct room costs were collected and analyzed. Measurements and Main Results: The groups were similar with respect to age, race, weight, medical comorbididties and pain. Length of stay and blood loss were significantly less in the robotic group. Total hospital cost was 76% higher in the Robotic group, $4104 vs $2335 (p⬍.05). In the robotics group, direct room costs were lower but direct operating charges were higher. Conclusion: Despite the multiple benefits of a robotically assisted sacrocolpopexy it is significantly more expensive than laparotomy. Cost, however, is only one of many factors we should use to evaluate new technologies in medicine and surgery. 124 Laparoscopic Removal of Sacrocolpopexy Mesh After Failed Conservative Management Flora RF, Switzer M, Babbitt T. Summa Health System/ NEOUCOM, Akron, Ohio Study Objective: Synthetic mesh erosion after sacrocolpopexy is reported to occur between 2.7% – 11% of cases depending on mesh type. Conservative therapy with topical estrogen therapy and excision of exposed mesh with vaginal advancement is usually attempted. We describe our technique for removal after failed treatment. Design: A retrospective chart review of three patients undergoing laparoscopic mesh removal of polypropelene mesh after failed conservative therapy. Setting: Urogynecology and reconstructive pelvic surgery practice in community based, university affiliated teaching hospital. Patients: Three patients underwent outpatient laparoscopic mesh removal after failed conservative therapy. Intervention: Laparoscopic excision using metal end-toend anastomotic sizer and harmonic scalpel. Cystoscopy with ureteral stent placement for identification was concomitantly performed. Copious irrigation with antibiotic solution was performed after removal. The defect was closed vaginally. Measurements and Main Results: All three removals were successfully completed on an outpatient basis. One patient developed a pelvic abcess requiring CT-guided drainage. One patient developed a recurrent peritoneovaginal fistula. Both were successfully resolved. Conclusion: Laparoscopic removal of mesh is feasible. Only one previous report of laparoscopic excision of mesh (Gore-tex) is in the literature. Abdominal excision from the presacral area can lead to hemorrhage. Due to the infected nature of the mesh and the complications encountered, consideration to use of a drain should be entertained.

S47 125 Retrospective Comparative Study of Tegress Versus Coaptite Flora RF, Purohit M, Babbitt T. Summa Health System/ NEOUCOM, Akron, Ohio Study Objective: Urethral bulking agents are used for the treatment of intricnsic sphincteric deficiency (ISD) of the urethra without urethral hypermobility. The objective was to compare clinical outcomes of Tegress versus Coaptite. Design: A retrospective chart review comparing patients receiving one of the two agents between June 2005 through February 2007. Setting: Urogynecology and reconstructive pelvic surgery practice in community based, university affiliated teaching hospital. Patients: Forty patients receiving one of the agents with urodynamic diagnosis of ISD (stress leak point less than 100 cm H2O) and q-tip angle less than 30 degrees. Intervention: Twenty-six patients received Coaptite and 14 receiving Tegress. Measurements and Main Results: Demographic data, number of treatments, subjective outcome, and complications (defined as catheter at discharge) were assessed. Coaptite; required less average number of treatments (1.2 versus 2.1). Coaptite; had a higher number of women dry or improved (92% versus 50%). More women were discharged home with a catheter with Coaptite; (42% versus 7%). All were removed by day 2. Conclusion: Coaptite appears to be less costly due to less number of treatments, more subjectively efficatious, and temporarily more obstructive than Tegress. A randomized controlled study is needed. 126 Robotic Sacrocervicocolpopexy in Women at Risk for Future Loss of Vaginal Support Flora RF, Maseelall P, Fanning J, Babbitt T. Summa Health System/NEOUCOM, Hudson, Ohio Study Objective: Women at risk of vaginal weakening such as current or future tamoxifen users or chronic heavy lifters may not be the ideal candidates for traditional sacrocolpopexies due to the risk of erosion and failure. The objective of this study was to describe our technique of sacrocervicocolpopexy immediately after the performance of a supracervical hysterectomy. Design: All women presenting with severe POPQ grade 3 to 4 uterovaginal prolapse underwent supracervical hysterectomy followed by immediate colpopexy using the cervical stump as the attachment point. All women had no prior history of abnormal cervical cytology and agreed to continue cervical screening after the procedure. Patients underwent preoperative evaluation including urodynamics. Patients were examined at 1 week, 1 /2/ 3 months, and 1 year postoperatively.