Minutes of Midlands Pelvic Floor Meeting

Minutes of Midlands Pelvic Floor Meeting 24th March 2015 Arden Hotel Birmingham

Chairperson: Andrew Miller

A huge thank you to Jacquie Hawthorne for stepping in and sponsoring the meeting.

Attendees: Andrew Miller,, Mark Chapman, Gurminder Matharu, Jon Lacy-Colson, Jacquie Hawthorn, Justin Yeung, Anur Miah, Salena Bains, Georgios Mistriotis, Daniel Couch, Paula Hughes, Kaori Futaba,

1. APOLOGIES

Chris Mayne, Doug Tincello, Chris Marmston, Vikas Shah, Sharad Karandikar

2. MINUTES OF THE LAST MEETING

These were accepted as a correct record

3. MATTERS ARISING FROM THE MINUTES

 Regional Training Day

A discussion took place regarding a training day. It was agreed that this needs to be actioned and put into place ASAP. Previously a survey monkey questionnaire had been circulated to trainees but no result was available. It was felt that any training day should be offered not only to Colorectal trainees but Gynaecology and Urogynaecology trainees throughout the region. The level of trainee at which the course is aimed at needs to be kept in mind.

Potential dates in September were discussed.

Unfortunately Chris Harmston was unable to attend .

ACTION: Andy Miller will liaise with him regarding the availability of training facilities.

Again the question of weekday or weekend came up – one option would be to run a pelvic floor business meeting the evening before the training day, similar to the Southern Pelvic Floor meeting and training day in Exeter earlier this month Kay Futaba informed the group that a training day timetable has been produced but that Richard Wilkin was away on annual leave and until he returns, she would be unable to circulate the proposal

ACTION: Kay to forward training day proposal to Andy Miller ASAP for circulation and discussion by the group. Together with the outcome of the survey monkey questionnaire

4. AGENDA ITEMS

 Overview of Bristol Meeting

Mark Chapman reported:

The website was now live: www.thepelvicfloorsociety.co.uk

There were discussions regarding establishment of what each unit is clinically undertaking and also about how to badge trainees and consultants.

A proposal about post CCT fellowships had been discussed but no firm conclusions reached.

There had been 8 units who had responded to Tony Dixon’s previous request regarding acceptance of complex cases requiring revisional surgery, particularly with reference to mesh complications.

The national database is still not up and running and this project has now been handed over to Charlie Knowles

The role of the MDT was again discussed what its format should be.

 Laparoscopic Ventral Mesh Rectopexy using synthetic mesh  Mr Ibrahim Eltilib, St James’s Hospital Leeds

An excellent presentation of his units results with very impressive outcomes. No mesh erosions to date were reported. Faecal Incontinece was markedly improved PAC QOL was very good Constipation was minimal However, 25% patients had a persistent problem after surgery.  Laparoscopic Ventral Mesh Rectopexy using biological mesh

Unfortunately Chris Harmston was unable to attend the meeting at short notice.

5. CASE DISCUSSION

68 year old lady with Faecal Incontinence and a Wexner score of 19/20 EUS showed obvious scarring Proctogram showed a small 2cm Rectocele that partially emptied ARP – globally week sphincter Endoscopy NAD Initially conservative treatment was tried and failed PTNS – not successful 2nd opinion – recommendation to fix the Rectocele

Awaiting a gynae review at this time

It was felt that Rectocele repair may not alter this lady’s symptoms and that if she is completely against a stoma a full and frank discussion would be required re irrigation or Rectocele repair (Jon Lacy -Colson patient)

74 year old lady 4 transanal procedures for prolaspe elsewhere – including at least 2 xAltermeier procedures

Now presented with further prolapse. Clinically no pelvic floor tone or musculature apparent

It was thought that the only option was a further resection sigmoidectomy, or stoma formation (Jon Lacy-Colson patient)

6. ANY OTHER BUSINESS Paula Hughes reported that at the recent Southern Pelvic Floor it was felt that all meetings – Northern, Midlands and Southern Pelvic Floor meetings should be open to all – This was universally supported by the group

The Pelvic Floor Sessions are on WEDNESDAY 24th JUNE 2015 at the DDF meeting in LONDON

There is a National Pelvic Floor Meeting in Manchester on 8/9th OCTOBER 2015 organised by Karen Telford The next Midlands pelvic Floor meeting date for 2015 will depend upon the date fixed for the training day (possible dates 5th or 12th September 2015– allowing for faculty availability)

A provisional date for 2016 meeting was 8th March 2016 at the ARDEN HOTEL BIRMINGHAM

Jon Lacy-Colson asked that Richard Foon- Consultant Urogynaecologist [email protected] was added to the circulation list

Can I ask that you encourage all of your colleagues and trainees with an interest in pelvic floor to attend the next meeting.

The meeting finished at 2130