Surgical Excision of Eroded Mesh After Prior Abdominal Sacrocolpopexy

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Surgical Excision of Eroded Mesh After Prior Abdominal Sacrocolpopexy Mary M.T. South1, Raymond T. Foster1, George D. Webster2, Alison C. Weidner1, Cindy L. Amundsen1 Duke University Medical Center Division of Urogynecology, Department of Obstetrics and Gynecology1 and Department of Urology2

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Financial Disclosure I have no conflict of interest to disclose.

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Background Abdominal sacrocolpopexy procedure using mesh is a durable surgical repair 3.4-12% risk of infection or erosion No prospective randomized trials have been performed comparing treatment of mesh erosion

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Background Methods of Surgical Excision of Eroded Mesh Abdominal excision Open transvaginal excision Transvaginal excision with the use of endoscopy (Romero et al. Am J Obstet Gynecol 2004)

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Study Objective To perform a retrospective analysis of patients at our institution who underwent mesh excision and compare the outcomes for these three different methods

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Methods IRB Exemption obtained Retrospective analysis Identified from CPT codes 49085 Removal of peritoneal foreign body from peritoneal cavity 57415 Removal of impacted vaginal foreign body under anesthesia 49010 Exploration, retroperitoneal area with or without biopsy(s) 57295 Revision (including removal) of prosthetic vaginal graft; vaginal approach

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Methods All excision procedures performed by members of the Divisions of Urogynecology and Female Urology at our institution. Outcome Success Lack of symptoms at follow-up Failure Persistent sinus tract with continued vaginal bleeding and/or discharge

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Methods Data recorded from transvaginal excisions Demographic characteristics Number of prior excisions performed at outside facilities Number and type of excision attempts performed Intra-operative and post-operative complications (including blood transfusions, pelvic abscess or bowel complications) Use of post-operative antibiotics Persistent symptoms of vaginal bleeding and/or discharge at follow-up

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Methods Data recorded from abdominal excisions Intra-operative complications Post-operative complications and any post-operative symptoms Persistent symptoms of vaginal bleeding and/or discharge at follow-up

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Results Charts reviewed on 31 patients who underwent excision of eroded vaginal mesh from a prior abdominal sacrocolpopexy procedure

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14 Open transvaginal 17 Transvaginal with endoscopy 1 lost to f/u Success 9/13 7/17 Total Vaginal Success 16 (53%) 12 on First Attempt 1 on Second Attempt 3 on Third Attempt Results of Transvaginal Excision

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Results All 7 patients (100%) who underwent abdominal excision had resolution of symptoms with only one attempt Increased morbidity Bowel injury Wound infection with breakdown Re-admission with post-operative fever Acute coronary syndrome

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Conclusions Transvaginal excision procedure Less invasive Less morbidity Outpatient procedure with a rapid recovery Abdominal excision procedure Gold standard Increased morbidity

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Study Strength Insight about excision methods that may improve outcomes in the future

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Study Limitations Small number of patients Retrospective analysis

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Future Studies Prospective, randomized study comparing different types of mesh excision methods Evaluate recurrent prolapse rates after complete excision of mesh Evaluate laparoscopic or robotic methods of excision

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Discussant Can you describe your rationale for how you decided which vaginal method to use? Of your successful transvaginal surgeries, in each group, how often were you able to completely remove the mesh and, were there subjects in whom you did not achieve complete removal and yet had complete resolution of symptoms?

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17 Transvaginal with Endoscopy 14 Open Transvaginal 12 Incomplete Removal 2 Complete Removal 1 No Follow-up 7 Success 4 Failure 2 Success 10 Incomplete Removal 5 Complete Removal 2 Unknown 8 Failure 2 Success 5 Success 2 Failure

Surgical infection

Abdominal trauma

Antibiotic Prophylax...

Early surgical thera...

Surgical Site Infection

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	mary.south@duke.edu 5 Years ago.



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