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Thursday 9th October 2014

Letter from the Chairman

Dear member TPFS & ACPGBI

Recent concerns about the complications of mesh use for POP and tape use for USUI have been discussed by our partner organisations (BAUS, BSUG), MHRA, the DOH and the Scottish Assembly. One of the action points arising was that the specialty organisations develop professional guidance on centres that are competent to carry out salvage surgery following mesh complications.

The Pelvic Floor Society welcomes and supports this initiative and the purpose of this letter is to address the surgical management of patients who suffer significant mesh complications following a laparoscopic ventral mesh rectopexy (LVMR).

The Pelvic Floor Society wishes to identify Centres that are prepared to deal with such complications and have the expertise to do so. These Centres should also be prepared to see patients who have not had an optimal result following a LVMR.

The Pelvic Floor Society calls for expressions of interest from specialist centers that offer salvage surgery for patients with mesh complications. The requirements for such a centre include:
• A regular MDT meeting
• Already treating complex cases of this nature
• Have established data collection
• Undertake regular audits of outcomes to include QoL
• A network of specialists who would be involved in the management of these cases – if necessary with other specialties e.g., urology and urogynaecology

If you want to be nominated as one of these centers please could you provide us with the following details:
1.Your institution’s name.
2. Comments relating to what types of procedure you would be prepared to see:

a. Erosions into back wall of vagina
b. Erosion into the rectum
c. Vault erosions
d. vesico-vaginal fistulae and other complex vesico-vaginal problems
e. Rectal strictures & perforations
f. Mesh removal for dyspareunia
g. Revisional surgery post failed LVMR

3.The number of each of the above performed in your unit in the last five years.
4. The number of “de novo” LVMRs performed in your unit over the last 5 years
5. Contact details (e.g. address, email) for referral purposes for your institution.
6. TPFS will inform MDs, CEOs and area teams throughout the country of those teams and individuals who should be offering this type of salvage surgery.

The Pelvic Floor Society is also working towards the establishment of standards and governance regarding pelvic floor surgery as well as training (based on the LAPCO model), and the reporting of outcome measures. Further details will be communicated later.

We also plan to start a mesh registry and move to an accreditation process for pelvic floor units in a similar way as the ACPGBI & BSUG recognizes colorectal and urogynaecology units.

Yours sincerely,

Tony Dixon

Tony Dixon, Chair TPFS Mark Chapman, Chair QA & Governance Committee TPFS