AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

AIM: the optimal extent of adhesiolysis for stoma takedown after Hartmann’s procedure is still unknown. This study is for evaluation the early and late results after partial and total dissection of adhesions during Hartmann’s reversal (HR).PATIENTS AND METHODS: a prospective non-randomized study included 99 patients with end colostomy. Fifty patients were included in the main group, in which partial adhesiolysis was performed during HR, and 49 — were the control group, in which complete dissection of adhesions was performed. The groups did not differ in the basic demographic characteristics, number of previous operations, and the severity of the adhesions.RESULTS: the operation time in the groups of partial and total adhesiolysis was 222 vs 205 minutes, respectively (p = 0.9). Injury of the intestinal wall occurred in 18 patients in the main group, and in 19 controls (p = 0.8). The postoperative stay was 12 in the main group vs 11 in the control (p = 0.7). The morbidity rate in the main group was 42% (n = 21), in controls — 29% (n = 14) (p = 0.2). Reoperations were performed in 4 patients of the main group, no reoperations in the control group were required, but no significant differences were obtained (p = 0.5). In the group of partial adhesiolysis, 1 fatal outcome was registered. By the regression analysis, the only factor increasing the likelihood of postoperative complications was a BMI > 35 kg/m2 (OR = 5.3; 95% CI: 1.5–21.2; p = 0.01).CONCLUSION: total adhesiolysis does not affect the operation time and traumatism of Hartmann reversal, does not increase morbidity rate.

AIM: to assess the postoperative complications rate in the groups with intra- and extracorporeal ileotransverse anastomosis in laparoscopic right colectomy.PATIENTS AND METHODS: a single-center, randomized, non-inferiority trial was conducted with intention-to-treat data analysis. There were two groups of patients in whom performed laparoscopic right colectomy using a standardized technique. In the main group (n = 39) intracorporeal ileotransverse anastomosis (IA) was formed, in the comparison group — extracorporeal anastomosis (EA) (n = 40).RESULTS: the operation time in the IA group was 192.4 ± 62.3, and in the EA group — 144.1 ± 41.3 minutes (p = 0.0002). The time of anastomosis formation was also significantly different: 53 (35; 71) minutes in intracorporeal and 30 (26; 35) minutes inn extracorporeal methods (p < 0.0001). The morbidity rate was not significantly different (25.6% vs 27.5%; p = 0.95). In the main group it was 25.6%, and in the control group 27.5% (p = 0.95). Postoperative hospital stay in the main group was significantly less — 5 vs 7.3 days in the comparison group (p < 0.001).CONCLUSION: the randomized trial demonstrated that IA is safe and comparable to EA in terms of the morbidity rate, despite its longer operation time. At the same time, in the IA group, patients achieved discharge criteria earlier, which reduced postoperative hospital stay.

AIM: to identify predictors of steroid resistance among patients with severe ulcerative colitis (UC). PATIENTS AND METHODS: the systematic review and meta-analysis were done, 18 observational case-control studies and 2545 patients with severe UC were included. RESULTS: the rate of patients with effective steroid therapy was 69.5%, and steroid resistance occurred in 30.5%. Pancolitis (OR = 1.5; 95% CI: 1.1–2) and endoscopic picture on the UCEIS ≥ 7 points (OR = 4.5; 95% CI: 3.2–6.5) were predictors of steroid resistance. The levels of albumin and C-reactive protein before the start and on the 3rd day of steroid treatment were also significantly corresponded with adverse outcome of the treatment (p < 0.00001). CONCLUSION: predictors of an adverse outcome are steroid resistance with pancolitis and endoscopic picture on the UCEIS scale ≥ 7 points. Hypoalbuminemia and high level of C-reactive protein were associated with the steroid resistance as well.

AIM: to identify risk factors of sigmoid volvulus in patients with idiopathic megacolon/megarectum. PATIENTS AND METHODS: the retrospective study included 151 patients with idiopathic megacolon/megarectum (2002-2023). The diagnosis of megacolon/megarectum was confirmed with a barium enema. Hirschsprung’s disease was excluded after anorectal manometry and (if needed) rectal wall biopsy by Swenson. RESULTS: forty-seven (31.1%) idiopathic megacolon/megarectum patients have had sigmoid volvulus in history or during current admission. In univariate analysis the significant correlation was revealed between sigmoid volvulus rate and age, rate of defecation without assistance, rate of integral parameter “defecation difficulties”, Wexner constipation scale rate (p < 0.05). There also was significant correlation between sigmoid volvulus rate and sigmoid length, sigmoid width, rectum width and rate of distal retention in gut transit test (p < 0.05). Due to multivariate analysis (multiple logistic regression) the best fit has the model, which sigmoid length, sigmoid width, and rectum width were included (Somers’ D — 0.867, KS statistic — 0.718, p < 0.0001). Sigmoid width (OR = 2.29; CI 1.38– 3.82) and rectum width (OR = 0.39; CI 0.22–0,72) were independent factors affected sigmoid volvulus rate. In the ROC analysis the area under the curve was 0.93 with a sensitivity of 82.4% and specificity of 89.2% in Youden’s point of 0.719. The nomogram for sigmoid colon volvulus risk prediction in idiopathic megacolon/megarectum patients was build up based this model. CONCLUSION: idiopathic megacolon is associated with risk of sigmoid volvulus. The risk of sigmoid volvulus more than 90% estimated with the nomogram can be considered as a reason for elective surgery in idiopathic megacolon/ megarectum patients without sigmoid volvulus in anamnesis.

AIM: to assess the relationship between clinical features and diagnostic tests results in idiopathic megacolon/megarectum patients.PATIENTS AND METHODS: the retrospective analysis of clinical manifestations and diagnostic tests included 157 patients with idiopathic megacolon/megarectum in 2002-2023. The diagnosis of megacolon/megarectum was verified with a barium enema, Hirschsprung’s disease was excluded byanorectal manometry and (if needed) rectal Swenson’s biopsy.RESULTS: the rate of integral parameter “abdominal discomfort” and Wexner constipation scale rate do not significantly correlate with barium enema, gut transit test, defecography and rectal compliance test results, besides of sigmoid colon width (p = 0.03). The rate of integral parameters “defecation difficulties” correlates with rectum width (p < 0.001) and do not correlate with gut transit time, results of defecography and rectal compliance test (p > 0.05). Distal contrast retention during gut transit test is associated with rectum width only (p < 0.01). The parameters of defecography do not correlate neither clinical features nor other diagnostic tests results (p > 0.05).CONCLUSION: there was not significant relationship between rate of abdominal discomfort, Wexner constipation scale rate and diagnostic tests results. The rate of integral parameters “defecation difficulties” significantly correlates with rectum width (based on barium enema) only. Rectum width seems to be most important parameter to assess the rectum function and in a minor degree — rectal compliance test. The defecography do not correlate either with the severity of clinical symptoms or with the results of other diagnostic methods, which casts doubt on the appropriateness of using this diagnostic test in patients with megacolon.

Введение: Лечение больных псевдомиксомой брюшины — одна из сложных и нерешенных проблем в онкологии. В отечественной медицинской литературе тема псевдомиксомы брюшины представлена единичными разрозненными публикациями. В основных зарубежных национальных клинических руководствах данная тема также не освещена. Основными документами, определяющими подходы к лечению псевдомиксомы брюшины, являются национальные консенсусы. Настоящий Консенсус является первой попыткой предложить стандартизованные подходы к проблеме псевдомиксомы брюшины в России.Методы: Настоящий Консенсус принят на основании анализа литературных данных, анализа известных зарубежных консенсусов, а также в результате серии обсуждений с участием специалистов, имеющих значительный личный опыт в диагностике и лечении псевдомиксомы брюшины.Результаты: Итоговый документ Консенсуса представлен в формате расширенных клинических рекомендаций, освещающих все аспекты данной патологии — эпидемиологию, патогенез, классификацию, клиническую картину, диагностику, и возможные варианты лечения, наблюдение после лечения и организационные вопросы.Заключение: Настоящий Консенсус создан с целью предложить практикующим врачам оптимальную стратегию лечения псевдомиксомы брюшины, а также информировать врачей (как онкологов, так и общего профиля) об особенностях данной редкой патологии.

OBJECTIVE: to compare the immediate and long-term results of endoscopic mucosal resection with a circular incision (C-EMR) and endoscopic submucosal dissection (ESD) in the treatment of patients with large benign epithelial neoplasms of the colon.PATIENTS AND METHODS: a prospective randomized comparative study was conducted from November 2020 to July 2022, included 103 patients with benign epithelial neoplasms of the colon ranging in size from 20 to 30 mm. The C-EMR method was used in 52, ESD - 51 patients.RESULTS: the removal of the tumor by the C-EMR method required statistically significantly less time, compared with the ESD method – 30 and 60 minutes, respectively (p<0.001). Intra- and postoperative complications occurred in 13(23.7%) patients in the C-EMR group and in 12(23.5%) patients in the ESD group. The most frequently reported complication was postcoagulation syndrome in the main and control groups – in 9(17.3%) and 11(21.6%) cases, respectively. It was found that the difficult location of the tumor (OR=18.3; p=0.01) and intraoperative complications (OR =37.5; p=0.04) are independent conversion factors of endoscopic intervention. The frequency of tumor removal in a en bloc and achievement of negative resection margins (R0) in the main and control groups did not significantly differ – 47(90.4%) and 49(96.1%) (p=0.4) and 40(76.9%) and 45(88.2%) (p=0.2), respectively.CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe operation comparable to endoscopic submucosal dissection, and can be the method of choice for benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In addition, the duration of the operation using the C-EMR method is two times less than using ESD.

AIM: to compare the clinical and diagnostic features and quality of life in patients with different types of idiopathic megabowel. PATIENTS AND METHODS: 157 patients with idiopathic megacolon/megarectum, confirmed by barium enema, were divided on 3 groups: 1) distal idiopathic megabowel (megarectum ± distal third of sigmoid colon dilatation); 2) idiopathic megacolon (variable extent of colon dilatation with a normal size rectum); 3) idiopathic megabowel (megarectum ± variable extent of colon dilatation). Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. RESULTS: the cohort included 70 (44.6 %) patients with distal idiopathic megabowel, 50 (31.8 %) patients with idiopathic megacolon and 37 (23.6 %) patients with idiopathic megabowel. Wexner constipation scale rate, rate of integral parameters “abdominal discomfort” and “defecation difficulties”, summary assessment of quality of life by IBSQOL questionnaire did not differ between groups (p > 0.05). At the same time patients with distal idiopathic megabowel were statistically significant younger (p < 0.01), had significant higher rate of faecal incontinence due to faecal impaction overflow (p < 0.01), had less often bowel movement. Also these patients had significant higher rate of distal contrast retention (p < 0.01) during gut transit test, but their colonic transit time was slight faster (p = 0.04).In multivariate analysis both megarectum (OR = 25.42; 95 % CI 5.01–128.92) and insufficiency of anal sphincter (OR = 4.71; 95 % CI 1.38–16.14) were independent predictors of faecal incontinence. The surgical treatment was performed most often in idiopathic megacolon group (p < 0.01), mainly due to colon volvulus. The most patients with distal idiopathic megabowel (97.1 %) were successfully maintained with a conservative treatment. CONCLUSION: there was not substantial difference in clinical features and quality of life in patients with different types of idiopathic megabowel, except of significant higher rate of faecal incontinence and less often bowel movement in distal idiopathic megabowel group. Faecal incontinence in these patients is linked disturbance rather intestinal, than anal component of continence. The necessity in surgical treatment was rising most often in cases of idiopathic megacolon. The conservative treatment was quite effective in most patients with distal idiopathic megabowel.

BACKGROUND: patients with rectal cancer after low anterior resections and with permanent colostomy inevitably face negative functional consequences of treatment. The question of anastomosis performing often remains unanswered. AIM: to compare the quality of life of patients with rectal cancer after low anterior resections and surgical treatment with a permanent colostomy.MATERIALS AND METHODS: literature search was performed in MEDLINE database according to PRISMA criteria using the keywords: “QoL”, “Quality of life”, “EORTC”, “low anterior resection” “rectal”, “stoma”, “ostomy” using suffixes [OR], [AND]. The meta-analysis included 9 retrospective studies with 2438 patients.RESULTS: no significant differences were found in global health status between the groups (p = 0.11). A significant difference with a worse score in ostomy patients is noted on the physical (p = 0.003), role (p = 0.002), emotional (p = 0.03) and social functioning (p = 0.004). In contrast, patients undergoing sphincter-preserving surgery have a higher incidence of constipation and diarrhea (p < 0.00001).CONCLUSION: patients with permanent stoma and after low anterior resections have comparable global health status. These patients have different profiles of disturbances in QoL patterns and functional consequences of surgery.

The purpose of the study: to identify risk factors for decreased quality of life in patients with permanent colostomy. The results of a survey of 114 patients with permanent stoma after radical surgical treatment of stage I–III rectal cancer were analyzed. The quality of life was assessed with EORTC QLQ-C30 questionnaire.Severe impact on the global health status (less than 50 points) was observed in 21 (18.4 %) respondents. The significant risk factors of impaired quality of life include the absence of preoperative stoma site marking (OR = 6.5, 95 %CI = 2.0–20.4; p = 0.002) and the lack of specialized stoma care service in the region of residence (OR = 4.6, 95 %CI = 1.6–13.1; p = 0.005). The emergency nature of the primary operation also had a significant negative impact on subsequent quality of life (OR = 6.1, 95 %CI = 1.8–20.1; p = 0.004). The employment had a positive effect on the quality of life of patients (OR = 0.2, 95 %CI = 0.07–0.9; p = 0.024). Conclusion. The quality of life of patients with a permanent colostomy after radical surgery for rectal cancer depends on several factors. The absence of preoperative stoma site marking, inaccessibility of the rehabilitation service for colostomy patients in the region, and surgery emergency negatively affect the quality of life of this category of patients.

OBJECTIVE:To compare the short-term results after left-sided laparoscopic colectomy with transanal and transabdominal specimen extraction.MATERIAL LAND METHODS:We selected 998 appropriate manuscripts and subsequently excluded 995 ones due to exclusion criteria. Thus, the meta-analysis was based on 3 randomized trials in accordance with PRISMA recommendations.RESULTS:A total of 353 patients were enrolled in meta-analysis including 169 resections with transanal specimen extraction and 184 surgeries with transabdominal extraction. Overall risk of postoperative complications (OR=0.60; 95% CI 0.31-1.14; p=0.12) including anastomotic leakage (OR=1.83; 95% CI 0.43-7.89; p=0.42) was similar in both groups. At the same time, severity of pain syndrome (mean difference = -2.35; 95% CI -2.51-2.19), time to the first flatus discharge (mean difference = -0.92; 95% CI -0.99-0.85) and postoperative hospital stay (mean difference = -1.5; 95% CI -2.03-0.98) were significantly lower in the group of transanal extraction (p<0.00001).CONCLUSION:Transanal specimen extraction in left-sided laparoscopic colectomy does not increase overall risk of postoperative complications. In addition, the NOSE technique has some advantages in short-term results compared to procedures with transabdominal specimen extraction.

Colon cancer is one of the most common malignant tumors worldwide. The main treatment for localized colon cancer is surgery. Nowadays laparoscopic colectomies for colon cancer have advantages over open ones, as they provide better short-term results. There has been a continuous improvement in the technique of the operation, and due to the widespread use of laparoscopic stapling and cutting devices, intracorporeal anastomosis is becoming more and more accessible. This article discusses the advantages and disadvantages of various methods for the formation of ileo-transverse anastomosis in laparoscopic right hemicolectomy.

PATIENTS AND METHODS: the retrospective study of clinical features and diagnostic tests results included 81 patients with idiopathic megacolon/megarectum (2004–2022). The diagnosis of megacolon/megarectum was confirmed with a barium enema, Hirschsprung’s disease was excluded based on anorectal manometry and (if needed) rectal Swenson biopsy. The QoL was assessed by IBSQOL questionnaire; clinical symptoms were assessed with a point scale. RESULTS: the quality of life in patients with idiopathic megacolon has most affected energy (emotional and physical) and physical role (work/main activity). In univariate analysis the significant correlation was revealed between QoL and age, sex, rate of defecation without assistance, rate of integral parameters “abdominal discomfort” and “defecation difficulties”, duration of anamnesis, Wexner constipation scale rate and gut transit time (p < 0,05). In the same time, the presence or absence of constipation or anal incontinence (leakage), colon and rectum sizes (based on barium enema), parameters of defecografy and rectal compliance test have not correlated with a QoL. No significant difference of QoL in patients added to conservative treatment and operated after. Due to multivariate analysis (multiple linear regression) the age and rate of “abdominal discomfort” and “defecation difficulties” were only independent factors affected quality of life. CONCLUSION: in terms of quality of life, idiopathic megacolon has the greatest impact on general tone and ability to perform basic professional activities. Independent factors that statistically significantly affect the assessment of quality of life are the age of patients and the severity of symptoms of abdominal discomfort and defecation disorders.

AIM : to improve the results of treatment of patients with «extremely severe» ulcerative colitis (UC). PATIENTS AND METHODS: A multicenter observational prospective «case-control» study was conducted. The study included 71 patients with «extremely» severe UC from June 2019 to October 2021. All patients underwent conservative therapy in accordance with current clinical guidelines. Evaluation of the effectiveness of treatment was carried out on the 3rd and 7th days of therapy, a "response" or "no response" to steroid therapy was stated. RESULTS : A total of 48 (68%) patients underwent surgical treatment during the follow-up period during hospitalization. 23 (32%) patients "responded" to conservative therapy and were discharged without colectomy. A reliable independent predictor of colectomy at the time of hospitalization was the level of albumin less than 29 g/l (OR – 8,6 95% CI: 2,5 – 39,9, p=0,002). On day 3, the reliable predictors were the level of C-reactive protein over 15.5 mg/l (OR – 9 95% CI: 2.4 – 46.1, p=0.003) and the value of the Mayo index above 7 points (OR – 13.3 95% CI: 3.3 – 75.7, p=0.0009). CONCLUSION : The study has demonstrated that the only reliable and independent predictor of colectomy at admission to the clinic is the level of albumin less than 29 g/l. Reliable factors that make it possible to evaluate and predict the effectiveness of therapy are the level of C-reactive protein more than 15.5 mg/l and the value of the Mayo index above 7 points on the 3rd day of therapy, as well as the level of C-reactive protein above 29 mg/l on the 7th day.

The article presents a comparative analysis of the small intestine strictureplasty and the resection method for the treatment of patients with Crohn's stricture. The results obtained showed the absence of any statistically significant differences between the two methods of surgical treatment. Thus, we can confidently speak about the safety of strictureplasty in patients with a complicated form of Crohn's disease.

The purpose of this work was to evaluate the preliminary results of Hartmann reversal procedures with total and partial adhesiolysis in the abdominal cavity. 64 patients with end colostomies were included in the randomized study from November 2021 to December 2022; 37 patients underwent partial adhesiolysis (main group) during the intervention, and 27 patients underwent complete adhesiolysis (control group). The study groups were comparable in gender, BMI, and status on the ASA scale. During the study, postoperative complications developed in 13 (35 %) cases in the group of partial adhesiolysis and in 6 (22 %) cases in the group of complete adhesiolysis (p = 0.4). In both groups, complications of classes I and II on the Clavien-Dindo scale prevailed. Complications requiring repeated surgical interventions developed in 3 patients of the main group: an anastomotic leak was detected in 2 (5 %) patients, and colon perforation was detected in 1 (3 %) patient, however, the groups were comparable in this parameter (p = 0.6). There was no statistically significant difference in the frequency and structure of postoperative complications or the duration of the postoperative inpatient days between the groups. The volume of adhesiolysis did not affect the duration of surgical interventions, which accounted for 224 minutes in the main group and 200 minutes in the control group. According to the results of regression analysis, the presence of previous peritonitis turned out to be the only predictor that increases the likelihood of postoperative complications (OR = 0.33; 95 % CI: 0.1–1; p = 0.049). Thus, the preliminary results of the randomized study showed no impact of the volume of adhesiolysis on the duration of the intervention and the nature and frequency of postoperative complications.Further research is necessary.