Aim: to assess the functional state of the pelvic floor muscles and their innervation in patients with descending perineum syndrome, manifested simultaneously by obstructive defecation and chronic neurogenic pelvic pain. Materials and methods: in 2022–2023, 51 patients (40 (78.4 %) women, 11 (21.6 %) men; age 50.9 ± 14.5 years) with pelvic organ prolapse, manifested by obstructive defecation and chronic neurogenic pelvic pain were examined at the Ryzhikh National Medical Research Centre for Coloproctology. All patients underwent high-resolution anorectal manometry and stimulation electroneuromyography according to a comprehensive neurophysiological protocol using a St. Mark’s electrode. Results: manometric patterns of functional defecation disorders were detected in 40 (78.4 %) patients, in the rest they were confirmed by defecography data and a negative evacuation test according to the Rome criteria IV. With stimulation electroneuromyography, neuropathy was detected in 68.6 % of cases by increasing the latency of the M-response of the pudendal nerve on the right or left. Complex neurophysiological diagnostics made it possible to additionally identify neuropathy in another 25.5 % of patients: according to changes in the mixed reciprocating reflex response (mixed feedback-reflex response) (efferent pathway) — in 17.7 % of cases; according to changes in the bulbocavernous reflex (efferent and afferent pathways) — in 7.8 % of cases. That is, neuropathy was determined in 94.1 % of patients in total. Conclusions: Functional diagnostic methods are an effective tool for studying the state of the pelvic floor muscle structures and their innervation and make it possible to identify pathogenetic links of disorders, the clinical manifestations of which are anal incontinence, neurogenic pelvic pain and proctogenic constipation in the form of obstructive defecation. Stimulation electroneuromyography makes it possible to detect disturbed innervation of the pelvic floor muscles and anal sphincter in the standard study of the M-response in 68.6 % of cases with perineal prolapse syndrome with a combination of proctogenic disorders and neurogenic pelvic pain. The use of a comprehensive neurophysiological protocol makes it possible to detect innervation disorders in 94.1 % of cases.

Aim : to evaluate the impact of primary tumor resection (PTR) on treatment outcomes in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases. Patients and Methods : treatment outcomes of patients with minimally symptomatic CRC and synchronous unresectable metastases were retrospectively assessed (2016–2022). Patients with PTR followed by chemotherapy were compared to patients receiving chemotherapy only. Survival was determined by the Kaplan-Meier method and differences were evaluated using the log-rank test and Cox proportional-hazards regression model. To reduce potential selection bias between two groups a propensity score matching (PSM) was performed. Results : no significant differences in 30-day mortality rate (р = 1,00) and the rate of surgical intervention due to complications of first treatment (р = 1,00) between the two groups. Before matching the median survivals were 27,8 and 24 months in the PTR and chemotherapy groups, respectively (р = 0,2). After PSM the overall survival rate at 3 years was 42,1% for the PTR group and 34% for the chemotherapy group (р = 0,47). The median survivals were 27,9 and 24,4 months, respectively. Three-year overall survival rate for patients with stage IVB was significantly higher in the PTR group than in the chemotherapy group (37,8% versus 4,8%; р = 0,02). The median survivals were 36,1 and 17,2 months, respectively. In multivariate analysis radical resection (R0) if unresectable metastases converted into resectable after initial treatment was the only significant prognostic factor for survival (p < 0,001). Conclusions : PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases is associated with acceptable postoperative morbidity and mortality rates and may improve overall survival for patients with stage IVB comparing to chemotherapy as a treatment of first line. However, randomized controlled trials are needed.

AIM: to assess the early results of hybrid laparoscopic endoscopic procedures for colon tumors. PATIENTS AND METHODS: a pilot “case-control” study included two groups of patients, who underwent surgery for endoscopic irremovable colon adenomas. Hybrid laparo-endoscopic procedures were done in the main group (n = 31), in the control group — laparoscopic resections of the colon (n = 20). RESULTS: no significant differences obtained in rate of postoperative complications: 9.7% in the main group vs 20.0% of cases in the control (p = 0.41). The postoperative hospital stay in the main group was significantly less than in control group — 5 versus 7 days (p < 0.0001). CONCLUSION: the hybrid laparoscopic endoscopic surgery does not associate with the increased risk of postoperative complications. Moreover, this procedure decreases postoperative hospital stay. However, a randomized controlled trial is required. ABSTRACT

The choice of medical rehabilitation in patients with anal incontinence is impossible without diagnostic data revealing the mechanism of fecal incontinence. The most promising are programs of comprehensive physiotherapeutic rehabilitation based on biofeedback training. The rate of anal incompetence (AI) after hemorrhoidectomy is 1.3-12.5%. However, in addition to the organic cause (surgical trauma), functional disorders of the external sphincter and pelvic floor muscles may contribute to the pathogenesis of anal incontinence, aggravating the incontinence symptoms after surgery. Therefore, these functional disorders should be diagnosed before surgery. However, medical rehabilitation programs for anal incontinence after hemorrhoidectomy are not standardized, and functional outcomes have not been studied.OBJECTIVETo evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery.MATERIALS AND METHODSA retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands).RESULTSComprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group.CONCLUSIONContraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

Coding according to D12 of the International Statistical Classification of Diseases and Health-Related Problems: Age group: adults.

This paper presents interdisciplinary consensus on the use of protocols of high-intensity magnetic stimulation for the treatment of pelvic floor muscles dysfunction with anal incontinence in Russia. AIM: to highlight the discussion and the decision-making on the basis of an interdisciplinary consensus on the use of a new algorithm of peripheral and transcranial magnetic stimulation in the treatment of pelvic floor muscles dysfunction with the clinic of anal incontinence. RESULTS: the adoption of this consensus can serve as a basis for further research of this problem and optimize the results of treatment of patients with pelvic floor muscle dysfunction with anal incontinence. The data may be interesting for a wide range of medical specialists: general practitioners, gastroenterologists, coloproctologists, surgeons, neurosurgeons, gynecologists, urologists — anyone who encounter with manifestations of this disorder in a routine practice and chooses diagnostic and treatment options. CONCLUSION: protocols for the treatment of anal incontinence using high-intensity magnetic stimulation aimed at improving the quality of treatment of patients with anal incontinence are based on the Russian experience of using the methods discussed and the analysis of the results obtained are validated.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить функциональные расстройства дефекации (ФРД) и анальной инконтиненции у пациенток с опущением и выпадением внутренних половых органов в сочетании с обструктивной дефекацией и влияние различных видов оперативных вмешательств на функциональные нарушения эвакуации и держания кишечного содержимого у этой категории пациенток. МАТЕРИАЛ И МЕТОДЫ Обследованы 26 пациенток с пролапсом тазовых органов и нарушением функции опорожнения прямой кишки. Для диагностики ФРД проводились аноректальная манометрия высокого разрешения, дефекография (оценка функциональных показателей опорожнения), эвакуаторная проба, комплексная сфинктерометрия, исследование проводимости по половому нерву. РЕЗУЛЬТАТЫ У больных с генитальным пролапсом манометрические признаки ФРД при натуживании выявлены в 69,23%, увеличение проводимости по половому нерву хотя бы с одной из сторон зарегистрировано у всех пациенток. Через 6 мес. после проведенного оперативного лечения отмечено снижение частоты ФРД до 42,3%. У четырех пациенток отмечено возникновение ФРД de novo. Жалобы на недержание газов и/или жидкого кала предъявляли 92,3% обследованных пациенток. Недостаточность анального сфинктера до операции была выявлена у 84,6% пациенток, после — у 69,23%. ЗАКЛЮЧЕНИЕ Исследование показало, что имеется как органический, так и функциональный генез нарушения опорожнения прямой кишки. При этом преобладающими оказались органические нарушения, что, на наш взгляд, оправдывает проведение пластических операций по поводу генитального пролапса, однако нельзя сбрасывать со счетов ФРД.

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants.

Введение. В патогенезе расстройств дефекации у больных с ректоцеле могут участвовать как анатомические, так и функциональные нарушения. Однако до настоящего времени о возможности консервативной терапии, направленной на коррекцию функциональных расстройств дефекации, изучены недостаточно. Цель: изучение эффективности использования методов включающих БОС-терапию (терапия биологической обратной связью, biofeedback терапия) и тибиальной нейромодуляции в лечении больных с функциональными расстройствами дефекации на фоне пролапса тазовых органов. Методика. Материалом исследования служили результаты обследования пациенток в возрасте от 18 до 75 лет с наличием функционального расстройства дефекации (ФРД) в сочетании с ректоцеле без ранее проводившихся попыток хирургической коррекции. Проведены оценка общеклинических данных, опрос при помощи специализированного опросника выраженности расстройств эвакуаторной функции толстой кишки, рентгеновская дефектография, аноректальная манометрия высокого разрешения до и после комплекса консервативной реабилитации при помощи БОС-терапии и тибиальной нейромодуляции. Результаты. Конечному анализу были доступны данные 60 пациенток. Ректоцеле 1-й степени выявлено у 3 человек (5%), 2-й - у 37 (61,7%), 3-й степени - у 20 (33,3%) участниц исследования. Средний балл по симптомному опроснику составил 11,4±3,7. ФРД I типа выявлено у 41 (68,3%), II типа - у 6 (10%), III - у 10 (16,7%) и IV - у 3 (5%) участниц. После проведенной БОС-терапии признаки ФРД полностью устранены у 36,7% (22/60) женщин с ректоцеле. Неэффективной БОС-терапия оказалась у 11/41 (26,8 %) пациенток с I типом манометрического паттерна, 2/6 (33,3 %) со II типом и 4/10 (40,0 %) пациенток с III типом ФРД; (всего у 17/60 (28,3 %). У пациенток с IV типом паттерна неэффективные результаты лечения отсутствовали. Заключение. БОС-терапия и тибиальная нейромодуляция приводят к устранению симптомов в 36,7% случаев и положительной динамике у 35,0% больных. Методы могут быть рекомендованы к использованию в комплексной терапии эвакуаторных расстройств дефекации у больных с ректоцеле Aim. To assess the efficacy of conservative methods like biofeedback therapy (BFB) and tibial neuromodulation (TNM) for treatment of patients with functional FDD and rectocele. Methods. Information collected during examinations of female patients with FDD and rectocele and with no previous surgery served as source data. Before and after conservative treatment with BFB and TNM, symptoms were assessed, responses to a specialized questionnaire on the severity of rectal evacuatory function impairment were analyzed, and X-ray defecography and high-resolution anorectal manometry were performed. Data before and after treatment were compared with non-parametric statistics (Wilcoxon matched pairs test). Results. The data of 60 women (mean age 48.2±13.4 years) were analyzed. Rectocele grade 1 was detected in 3 (5%), grade 2 in 37 (61.7%), and grade 3 in 20 (33.3%) patients. Mean symptom score on the specialized questionnaire was 11.4±3.7. FDD type 1 manometric pattern was found in 41 (68.3%), type II in 6 (10%), type III in 10 (16.7%), and IV in 3 (5%) participants. Complete resolution of FDD after BFB and TNM therapy was found in 22/60 (36.7%) of women. BFB and TNM therapy was ineffective in 11/41 (26.8%) patients with FDD type I, in 2/6 (33.3%) with type II, and in 4/10 (40.0%) patients with type III FDD. This conservative treatment was effective in 100% patients with type IV pattern of FDD. Based on the results, we suggest further actions to improve the outcomes of conservative treatment. Conclusion. Conservative treatment with combined biofeedback therapy and tibial neuromodulation may help improve symptoms in 35% of patients and lead to complete resolution of functional component in 37% of patients with functional defecatory disorders and rectocele. This treatment was not effective in 28% of patients.

With the aim to find the genetic cause of adenomatous polyposis, DNA samples from six members of the same family (three affected patients, two healthy individuals, and one individual with unknown disease status) were examined via whole exome sequencing and segregation analysis. Previously, no APC/MutYH mutations were found in one patient by Sanger sequencing despite all the symptoms of adenomatous polyposis syndrome. As a result of bioinformatic analysis of data obtained from four blood relatives (three affected patients and one individual with unknown disease status), the mutation in the NSUN7 gene was observed, which was not previously associated with the development of adenomatous polyposis. However, subsequently, the population frequency of this genetic variant in Russia appeared to be significantly higher than the incidence of adenomatous polyposis itself. Additional bioinformatic analysis of copy number variation (CNV) revealed previously undescribed large heterozygous deletion in three patients, which included exons 2–16 of the APC gene and regions of the SRP19 and REEP5 genes, which was subsequently confirmed by Multiplex Ligation-dependent Probe Amplification (MLPA). The conducted molecular-genetic study demonstrated the need to develop and constantly update the national database with variants detected under high-throughput sequencing. In addition, the necessity to search for large deletions in the APC gene in Russian patients with adenomatous polyposis has also been established.

The aim of the review is to show possible links between intestinal microbiota and colorectal carcinogenesis, to describe the procarcinogenic properties of microorganisms associated with the development or proliferation of colorectal cancer. The gut microbiota plays a leading role in metabolism, providing important metabolites to the macroorganism. In humans, there is a spatial variability in the qualitative and quantitative microbiota composition. The intestinal microbiota provides the colony resistance, protecting it from colonization by opportunistic and pathogenic microorganisms. There is more and more data on the role of the gut microbiota in the development of colorectal cancer. The profound study of the gut microbiome in various populations is required, which will allow to identify other microorganisms associated with the development or proliferation of colorectal cancer. It can be used as biomarkers for colorectal cancer screening and predicting the response to immunotherapy.