Charles Knowles will chair the Faecal Incontinence session at ESCP Virtually Vilnius 2020. We asked him about the great line up that's in store for delegates this September at #ESCP2020.
Charles is Chair of ESCP's Research Committee and Professor of Surgery at Barts and The London School of Medicine and Dentistry. His main clinical and research interests are pelvic floor, functional coloproctology, enteric neuroscience and trial design.
Please introduce the subject
The session is entitled 'faecal incontinence' and that’s what it will cover right from brief core subject update for all trainees, through to some pretty super-specialist topics.
Miss Carrington wrote her PhD thesis on anorectal physiology and she also led the UEG-funded (ESCP supported) International Working Group for anorectal physiology (technical guidance and diagnostic classification published 2019). She will focus on supra-sphincteric mechanisms of incontinence which are now regarded by many as more important than sphincter integrity itself.
The slightly controversial question of when to still repair the anal sphincter follows from this understanding and will be covered by Professor Ratto who has published widely on the subject, especially in relation to non-obstetric trauma e.g. after fistula surgery.
Professor Lehur will address other surgical approaches including those at an early stage of evaluation and I am sure he will have much to say about neuromodulation, a point that can be taken up by the panel considering that one of the pioneers of Sacral neuromodulation (Prof Matzel) will be leading the discussion. He will also be presenting the standardised technique for performing the procedure (a critical point in its outcome). I shall be interested to see what is now regarded as the best way to perform an anoplasty.
Why is it an important topic?
Faecal incontinence is a pretty important subject if you’re the person suffering from it and it is not uncommon (9% adults have some degree of symptoms and 1.5% have severe symptoms). That noted, it doesn’t get the attention or resource of many ‘mainstream’ colorectal diseases and its management is often left to a minority of enthusiastic subspecialists. As our European populations are getting older, it is incumbent on every colorectal surgeon to have some knowledge of this subject even if this is to make some sensible decisions about early management before referral to a specialist centre.
What are the key points to know?
The audience should take away a basic understanding of the causes, diagnostic investigation and management of FI. Further they should understand that while the anal sphincter may seem to have primacy in the barrier to leakage, it is only a part player in the advanced pathophysiology of FI. Thus repairing it does not often make sense. Those performing SNM should know who to choose for this procedure and how to do it properly so that the electrode lead lies adjacent to the sacral nerve.
Why is the session different/useful to attend - and who will benefit most from attending?
This session is for everyone from trainees to seasoned consultants (unless they genuinely never see patients with FI which is a little unlikely) – even our cancer colleagues have LARS to deal with.
What are the future developments in the field?
If you attend you will find out!
The Faecal Incontinences session at ESCP Virtually Vilnius 2020 will take place between 17:10-19:10 CEST on Tuesday 22 September.