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1565 Laparoscopic Management of Endometriosis Presenting with Massive Recurrent Hemoperitoneum
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 private insurance. Public insurance was significantly associated with older age, a smaller proportion of White/Caucasian race, higher BMI, higher gravidity, higher parity, a smaller proportion of married patients, more chronic medical conditions, and lower employment rates (all p<0.05). Unadjusted analysis of outcomes in the sample showed that public insurance was significantly associated with a higher average percentage of ‘no show’ appointments when compared to private insurance (1.9% vs 0.8%; p<0.01) and that public insurance was significantly associated with having at least 1 ‘no show’ appointment when looked at categorically (6.5% vs 2.5%; p<0.01). After adjusting, those who were publicly insured were 2.24 times more likely to have had at least 1 ‘no show’ appointment compared to those who were privately insured (95% CI: 1.03 − 4.88; p=0.04). No statistically significant differences were detected between public and private insurance when looking at time from initial consult to surgery, attended appointments, or canceled appointments. Conclusion: Patients with public insurance were more likely to missed scheduled appointment than those with private insurance. There was no difference between groups temporally from initial consult to surgery. Further research needs to be conducted to understand what socioeconomic factors impact publicly insured patients’ access to appointments and how to remove those barriers. Virtual Poster Session 3: Basic Science/Research/Education (9:50 AM − 10:00 AM) 9:50 AM: STATION D 2982 Discrepancies Between Author- and IndustryReported Disclosures of Financial Relationships in Gynecologic Research Wong JM,1,* Guo XM,1 King NR,1 Milad MP2. 1Obstetrics and Gynecology, Northwestern University, Chicago, IL; 2Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL *Corresponding author. Study Objective: To investigate the concordance between author disclosures of financial and commercial interests and the data available on reported industry transactions present in the Centers for Medicare & Medicaid Services Open Payments database (OPD). Design: Data was collected from an abstract booklet for a 2018 gynecologic annual meeting, including information on author specialty, number of abstracts published, and the number and nature of the listed disclosures. This was compared to data available for each author in the OPD in 2017, which included the amount and nature of all industry payments. Setting: Retrospective observational study. Patients or Participants: All authors with abstracts published in a 2018 gynecologic annual meeting abstract booklet. Interventions: N/A. Measurements and Main Results: A total of 544 authors were identified in the abstract booklet. Of these authors, 515 (94.7%) had no disclosures listed while 29 (5.3%) had one or more disclosure listed. Of the 515 authors without any disclosures, 219 (42.5%) had industry payments recorded in the OPD. A majority (1690/2514, 67.2%) of the industry payments were categorized as “Food and Beverage” payments. Of 16 authors with multiple abstracts and at least one disclosure listed, 12 (75.0%) had discordance in reported disclosures between their own abstracts. In total, 244 (44.8%) authors were found to have industry relationships in the OPD, comprising over 2.2 million dollars of industry payments with a median payment of $76.46 (IQR $22.52-$179.85). Conclusion: Many authors at a major gynecologic annual meeting did not correctly disclose some or all of their industry relationships, and those that did often failed to correctly disclose those relationships across their presented work. A majority of payments, however, were related to food and beverage transactions and the median payment overall remained low.
S167 Virtual Poster Session 3: Endometriosis (9:50 AM − 10:00 AM) 9:50 AM: STATION E 1565 Laparoscopic Management of Endometriosis Presenting with Massive Recurrent Hemoperitoneum Gonzalez AM,1 Carugno JA,2,* Artazcoz S,1 Elorriaga F,1 Qui~ nonez A,1 Palin H,3 Timmons D3. 1Obstetrics and Gynecology, Hospital Naval Pedro Mallo, Buenos Aires, Argentina; 2Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Pembroke Pines, FL; 3 Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, FL *Corresponding author. Video Objective: To describe the clinical characteristics and laparoscopic findings of a patient with endometriosis presenting with hemorrhagic ascites. Setting: University teaching academic level IV hospital. Interventions: Diagnostic laparoscopy, drainage of hemoperitoneum and multiple peritoneal biopsy. The medical management of this rare condition is also discussed. Conclusion: Endometriosis should be a differential diagnosis in women of reproductive age presenting with massive hemorrhagic ascites. Diagnostic laparoscopy with drainage of hemoperitoneum is a feasible option to obtain a pathology confirmed diagnosis of patients presenting with hemoperitoneum secondary to pelvic endometriosis. Awareness of this condition will prevent unnecessary aggressive resection commonly performed when confused with ovarian cancer. Virtual Poster Session 3: Endometriosis (9:50 AM − 10:00 AM) 9:50 AM: STATION F 1772 A Novel Technique: Mesh Repair After Excision of Rectus Muscle Endometriosis Melnyk A,1,* Chao L,2 Lee TT3. 1OBGYN, UPMC, Pittsburgh, PA; 2 University of Texas Southwestern, Dallas; 3UPMC, Pittsburgh *Corresponding author. Video Objective: The purpose of this video is to demonstrate the laparoscopic excision of rectus muscle endometriosis and repair utilizing mesh. This video will review imaging that identifies rectus muscle endometriosis, demonstrate when mesh should be used, and describe techniques utilized to place mesh. This video also demonstrates the use of an omental flap to prevent the formation of adhesions. Setting: Stepwise demonstration of techniques with narrated video footage and presentation of three case reports at a single academic medical center. Interventions: The laparoscopic excision of rectus muscle endometriosis can be challenging due to the location and extent of disease. A pelvic MRI can be used if suspicion of rectus muscle endometriosis is present. When encountering rectus muscle endometriosis, the use of ultrasoundguided wire localization can help identify smaller, non-palpable lesions. A subxiphoid port and a 45-degree angled laparoscope can be used to achieve optimal visualization. Depending on the size of the defect, mesh may need to be placed to repair the fascia. This can be performed with absorbable tacks, but if the required mesh is large in size, it may require suture as well. Finally, an omental flap can be utilized as a barrier between bowel and the mesh to prevent the future formation of adhesions. Conclusion: Rectus muscle endometriosis is a rare cause of pelvic pain, but when diagnosed, can be successfully treated with a laparoscopic excision. A pelvic MRI can aid with diagnosis and help with surgical planning. Treatment involves wide surgical excision and if the resulting fascial defect is large, mesh may be utilized to repair the defect. Consideration of an omental flap can also be used to prevent future adhesions.
S167 Virtual Poster Session 3: Endometriosis (9:50 AM − 10:00 AM) 9:50 AM: STATION E 1565 Laparoscopic Management of Endometriosis Presenting with Massive Recurrent Hemoperitoneum Gonzalez AM,1 Carugno JA,2,* Artazcoz S,1 Elorriaga F,1 Qui~ nonez A,1 Palin H,3 Timmons D3. 1Obstetrics and Gynecology, Hospital Naval Pedro Mallo, Buenos Aires, Argentina; 2Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Pembroke Pines, FL; 3 Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, FL *Corresponding author. Video Objective: To describe the clinical characteristics and laparoscopic findings of a patient with endometriosis presenting with hemorrhagic ascites. Setting: University teaching academic level IV hospital. Interventions: Diagnostic laparoscopy, drainage of hemoperitoneum and multiple peritoneal biopsy. The medical management of this rare condition is also discussed. Conclusion: Endometriosis should be a differential diagnosis in women of reproductive age presenting with massive hemorrhagic ascites. Diagnostic laparoscopy with drainage of hemoperitoneum is a feasible option to obtain a pathology confirmed diagnosis of patients presenting with hemoperitoneum secondary to pelvic endometriosis. Awareness of this condition will prevent unnecessary aggressive resection commonly performed when confused with ovarian cancer. Virtual Poster Session 3: Endometriosis (9:50 AM − 10:00 AM) 9:50 AM: STATION F 1772 A Novel Technique: Mesh Repair After Excision of Rectus Muscle Endometriosis Melnyk A,1,* Chao L,2 Lee TT3. 1OBGYN, UPMC, Pittsburgh, PA; 2 University of Texas Southwestern, Dallas; 3UPMC, Pittsburgh *Corresponding author. Video Objective: The purpose of this video is to demonstrate the laparoscopic excision of rectus muscle endometriosis and repair utilizing mesh. This video will review imaging that identifies rectus muscle endometriosis, demonstrate when mesh should be used, and describe techniques utilized to place mesh. This video also demonstrates the use of an omental flap to prevent the formation of adhesions. Setting: Stepwise demonstration of techniques with narrated video footage and presentation of three case reports at a single academic medical center. Interventions: The laparoscopic excision of rectus muscle endometriosis can be challenging due to the location and extent of disease. A pelvic MRI can be used if suspicion of rectus muscle endometriosis is present. When encountering rectus muscle endometriosis, the use of ultrasoundguided wire localization can help identify smaller, non-palpable lesions. A subxiphoid port and a 45-degree angled laparoscope can be used to achieve optimal visualization. Depending on the size of the defect, mesh may need to be placed to repair the fascia. This can be performed with absorbable tacks, but if the required mesh is large in size, it may require suture as well. Finally, an omental flap can be utilized as a barrier between bowel and the mesh to prevent the future formation of adhesions. Conclusion: Rectus muscle endometriosis is a rare cause of pelvic pain, but when diagnosed, can be successfully treated with a laparoscopic excision. A pelvic MRI can aid with diagnosis and help with surgical planning. Treatment involves wide surgical excision and if the resulting fascial defect is large, mesh may be utilized to repair the defect. Consideration of an omental flap can also be used to prevent future adhesions.