Rohan Gujjuri interviews Paul Lehur, part-time Consultant in the Pelvic Floor Unit at Ospedale Regionale di Lugano in Ticino in Switzerland.
He has a long-standing interest in pelvic floor disorders with his main clinical and research interests concerning the management of functional disorders of the lower gastrointestinal tract. Paul has been instrumental in the recent technical development of the magnetic reinforcement device for the treatment of faecal incontinence.
Paul will talk at Virtually Vilnius in September on Minimally Invasive and Novel Surgical Techniques for Faecal Incontinence.
Faecal incontinence significantly impairs the quality of life of afflicted patients, especially when symptoms are severe: i.e. a chronic leakage of faecal material at least once a week. Several surgical procedures have been described to help manage these latter patients. The least invasive techniques are looked for to treat them as efficiently as possible. Among these, sacral neuromodulation is currently the standard of care. Other available options include injectables with the Sphinkeeper™ being the most promising in this range of treatment. Intensive research is currently being conducted for the use of stem cell injections to restore continence. At present artificial sphincters are no longer available for clinical use.
It is also worth keeping in mind some non-surgical non-invasive options based on enemas or disposable plugs for temporary control of leakage.
We spoke to him about what delegates can expect from his talk.
Rohan Gujjuri: What do you want to add to the subject?
Paul Lehur: Faecal Incontinence as a symptom is found in a variety of conditions and requires a personalized team management that is not always easy to implement. It is a complex field as, despite being a chronic disorder, symptoms may vary over time. Faecal incontinence is frequently associated with bowel conditions such as irritable bowel syndrome or constipation, that have an impact on the effectiveness of the treatments as well has patient’s psychological behaviour.
The number of patients to treat is relatively small as conservative management, which is always a first step in Faecal Incontinence management, is frequently successful. But patients and caregivers have conflicting views on the condition, its management and results of the therapy.
RG: What are the key points to know?
PL:
- A basic knowledge on faecal incontinence origins and causes is required
- Appropriate selection of patients for the treatment options described is key
- Choice of surgical treatment is a decision of a specialised MDT
- Sound implementation of the chosen surgical treatment at its different steps is required
- Assessment of therapy results, best in trials/registries is mandatory with a long-term objective
RG: Why is this talk different and useful to attend?
PL: This presentation aims to update the audience on the current faecal incontinence management pathways, not so much based on numerical study results, but more in the way the patient is informed and approached (compassionately and realistically) about the treatment options of his/her condition. This is in line with the current recommendation “First do not harm” that prevails today when treating functional bowel disorders.
RG: What are the future developments in the field?
PL: There is intensive research underway in the field of faecal incontinence and it is worth following not only the breakthroughs, such as those coming from regenerative medicine, but also implementing in one’s practice the progress made with current options, as seen with new SNM devices smaller/MRI compatible for instance.
Paul’s talk on ‘Minimally Invasive and Novel Surgical Therapies for Faecal Incontinence’ at #ESCP2020 will take place at 17:55 on Tuesday 22nd September.
