Aim. To evaluate the effectiveness of the cultural and linguistic adaptation of the Fecal Incontinence Quality of Life Scale (FIQOL) for the Russian-speaking population.Methods: A cultural and linguistic adaptation of the FIQL questionnaire was performed in accordance with international guidelines. This process included several key steps: professional translation of the questionnaire, back translation, and critical discussion within an interdisciplinary council comprising translators, linguists, psychologists, doctors, and patients. Preliminary testing and reliability assessment were also conducted. The results of the preliminary testing are presented in this article. A total of 26 patients who had undergone surgical treatment for anal incontinence (sphincterolevatoroplasty) between 2016 and 2022 participated in the preliminary testing phase.Results. The result of the cultural adaptation is the Russian language version of the Fecal Incontinence Quality of Life Scale (FIQOL), which has undergone all the aforementioned stages with corrections and comments in the order of the council of doctor-translator-psychologist-patient. The average time elapsed from the moment of surgery to the survey was 32 months (SD = 20). The average overall score of the questionnaire was 3.2 (SD = 0.62), the average score on the ‘Lifestyle’ scale was 3.3 (SD = 0.74), the average score on the ‘Behaviour, daily worries’ scale was 3.2 (SD = 0.65), the average score on the ‘Depression and self-perception scale was 3.4 (SD = 0.91) and the average score on the ‘Shame’ scale was 3.2 (SD = 0.71). The assessment of the reliability of the questionnaire, as shown by the alpha-Kronbach coefficient, was 0.94, which corresponds to the assessment of ‘very good reliability’.Conclusion. The presented data show that the Russian version of the Fecal Incontinence Quality of Life Scale (FIQOL) is adapted for use by Russian-speaking patients and specialists, is reliable, and can be used as a primary tool for assessing the quality of life of patients with anal incontinence.

The authors consider the influence of carbohydrate metabolism disorders on postoperative period. Data on the influence of diabetes mellitus on morbidity are summarized. Mechanisms and significance of stress-induced hyperglycemia are described. The authors also discuss modern approaches to the treatment of hyperglycemic conditions in perioperative period.

OBJECTIVE:To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation).METHODS:A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum.RESULTS:At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol.CONCLUSION:The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.

A review of the current national and foreign literature is devoted to epidemiology, risk factors, causes, diagnosis and modern treatment approaches for fecal incontinence (FI). Incidence of FI in early and delayed period after childbirth is 30% or more. At the same time, up to 87% of postpartum injuries of anal sphincter remain undiagnosed. Importantly, routine caesarean section does not reduce the risk of incontinence. In addition to typical complaints of spontaneous gas and stool, diagnosis of FI after childbirth includes transrectal ultrasound, MRI, anorectal manometry and pudendal nerve terminal motor latency testing. Survey of proctologists from different regions of Russia revealed a high demand from medical community for educational programs devoted to diagnosis, treatment and rehabilitation of patients with postpartum perineal injuries.

OBJECTIVETo compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair.MATERIAL AND METHODSIt is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated.RESULTSEarly postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%).CONCLUSIONThere were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.

The incidence of multiple primary oncological diseases ranges from 2.4% to 17%. The main causes of primary multiple diseases include factors related to the patient's lifestyle, environmental and genetic factors, as well as factors related to the comprehensive treatment of previously identified malignant diseases.We demonstrate a clinical case of treatment of a patient with synchronous primary multiple cancer of the sigmoid colon and breast in combination with spinal cord meningioma. An interesting fact is the possible correlation between meningioma and breast cancer. Thus, the risk of meningioma in women who have had breast cancer and the risk of breast cancer in women with a history of meningioma is moderately increased (RR = 1.40-1.64 and 1.54, respectively). This two-way statistical association may be a consequence of common risk factors and a partial coincidence of gene-environmental interactions that determine carcinogenesis. Further research is needed to identify problems of prevention, screening, diagnosis, treatment and disease-free survival. It is important that patients diagnosed with cancer have information about possible late and long-term consequences of treatment and its symptoms, as well as possible signs of relapse and the appearance of secondary tumors. It is important that patients receiving treatment for malignant neoplasms follow the recommendations for cancer prevention and early detection, including smoking cessation, physical activity, nutrition and diet, a healthy weight and all standard cancer screening tests.

Background. Lack of universal diagnostic parameters that can accurately and reliably diagnose presence of a malignant neoplasm, anticancer drug effectiveness or metastasis development including dormant ones and also to detect the progression or relapse of the disease at an early stage put on the first place studies related to the identification of such markers. Increased secretion and activity of the urokinase type plasminogen activator (uPA), its receptor (uPAR) accompany many types of malignant neoplasms, contributing their progression and metastasis, as well as the emergence of chemoresistance. So today these proteins are promising diagnostic targets in oncology. Aim. To evaluate the diagnostic significance of the expression levels of uPA and uPAR in blood serum of patients with colorectal and gastric adenocarcinoma and uPA/uPAR distribution in samples obtained from the primary tumor node, to assess the possibility of their use as universal diagnostic indicators in cancer patients at the stage of primary treatment. Materials and methods. The study included patients with colorectal and gastric adenocarcinoma in the amount of 50 people and 25 healthy volunteers. The content of uPA and uPAR in blood serum was assessed by enzyme-linked immunosorbent assay, the level of expression of the studied proteins in tumor tissue was assessed using immunohistochemical staining with antibodies to uPA and uPAR. Results. It was found that in comparison with healthy donors uPA serum concentration was significantly higher in all patients with adenocarcinoma, regardless of gender, and the uPAR content in the blood serum was significantly higher in women. Immunohistochemical staining data showed that the expression of these two proteins in tumor tissue significantly exceeds their expression in normal tissue. Conclusion. Based on the obtained data the possibility of using uPA in blood serum as a universal diagnostic criterion in patients with colorectal and gastric adenocarcinoma regardless of gender was shown and uPAR in female patients.

Introduction: Hirschsprung's disease (HD) is a relatively rare condition, in which the intermuscular (Auerbach) and submucosal (Meissner) plexus are absent in the colon wall at various lengths. In the literature, HD is described mainly in relation to the pediatric surgery area of interests because up to 90% of cases of this disease are detected before the age of 5 years 6. However, in some patients, the symptoms of the disease are not severe, so patients survive to adulthood without an established diagnosis.Clinical case: we demonstrate our experience of surgical treatment of Hirschsprung's disease in a 18-year-old patient.Conclusion: Although Hirschsprung's disease is in most cases a disease of childhood, it is necessary to keep in mind its typical symptoms when an adult patient complains of constipation. Proper diagnosis and correctly selected surgical treatment can not only eliminate symptoms and improve quality of life, but also reduce the likelihood of serious complications.

Despite all the achievements of modern surgery, the number of postoperative infectious complications in the world remains high. Their occurrence leads to a longer period of patients’ hospitalization, requires the use of additional medical and diagnostic measures, which ultimately leads to higher treatment costs and significant financial losses in the health care system. Therefore, it is important to identify postoperative complications at an early stage, even before the development of pronounced clinical symptoms, and to predict their possible development in a certain category of patients. For these purposes, scientists try to use various laboratory markers. In this paper, we analyzed both well-known indicators of the inflammatory response, such as: C-reactive protein, albumin, their ratio, procalcitonin and interleukin-6, and relatively new parameters that research teams are trying to apply for these purposes: neutrophil granularity intensity and neutrophil reactivity intensity, pancreatic stone protein and pancreatitis-associated protein. We tried to collect the most complete information available at the moment, evaluate the opinions of researchers, identify contradictions in their works and try to explain their cause. As a result, it turned out that even the markers of inflammation known for many years are not absolutely specific for postoperative infectious complications. We concluded that most of the laboratory parameters described in this article can be used to some extent in the early diagnosis of postoperative infectious complications, but if we want to obtain more complete information in this area of knowledge, it is necessary to conduct new largescale studies.

During the care of patients with novel coronavirus infection at the Lomonosov MSU Medical Research and Education Center from April 21 to June 13, 2020, we observed cases of spontaneous mediastinal emphysema (spontaneous pneumomediastinum) as a manifestation or a probable complication of COVID-19.The aim of the paper. To provide clinical case descriptions and approaches to the management of patients with spontaneous pneumomediastinum in COVID-19 associated pneumonia, as they are not addressed in the current clinical guidelines, and therefore are worthy of special attention.Among 224 patients with laboratory-confirmed diagnosis of the novel coronavirus infection COVID-19, five cases of pneumomediastinum without pneumothorax were identified. Of these, in two cases the pneumomediastinum developed during noninvasive lung ventilation (NLV) (one case) and invasive lung ventilation (one case). In three cases, spontaneous mediastinal emphysema was not associated with lung ventilation. By the time of publication, one case of pneumomediastinum was completed, and four patients remained hospitalized. All five patients were males aged from 52 to 84 years.This paper presents in depth the description of two cases of mediastinal and subcutaneous emphysema in patients with COVID-19.

Ventral hernia is still one of the most common reason for scheduled and emergency surgery. The review is designed to reveal relationships between metabolism in extracellular matrix of connective tissue and pathogenesis of ventral hernias. These data will be valuable to develop a personalized approach to the treatment of these patients.

Aims : assessment of the safety of early closure of temporary ileostomy in patients with rectal cancer after the total end partial mesorectal excision. Materials and methods : participants: patients of our clinical centers were examined with CT-proctography or rectoscopy to check whether bowel anastomoses were intact on 8-th day after the primary surgery. Patients with intact anastomoses who fulfilled the inclusion criteria were randomized to 2 groups: the first group, (n=37) with early closure of ileostomy (day 8-13 after stoma formation) and the second group (n=39) with deferred closure (after 12 weeks). It was expected that early closure would be a safe procedure. Results : 76 participants were randomized; results of their treatment were analyzed. Time boards of reconstructive surgery do not result in terms of postoperative complications (8.1% in 1-st group versus 7.7% in control, p=0,08, not significant). However duration of reconstructive surgery in the group with the early closure of ileostomy was shorter (Tm in 1-st group = 51 min (28-127) versus 70 min (30-135) in second group, duration of surgery in intervention group was shorter in 1,37 times that one in control group (95% CI 1,28-1,46, p=0,02)). Conclusion : early closure of ileostomy in patients after surgery for rectal cancer is feasible and doesn’t result in an increase the number of postoperative complications; it may be considered as an alternative to deferred closure. However, this problem should be studied in greater depth to evaluate both complications associated with ileostomy and the quality of the life.

Primary multiple malignancies are rarely observed in clinical practice. Literature data indicate the existence of potential risk factors, primarily genetic ones (Li-Fraumeni or Beckwith–Wiedemann syndromes) for the development of such diseases. Most of the tumors found in various organs are metachronous. This paper presents a variant of managing a patient with primary multiple neoplasia of the kidney, prostate, and colon. The patient (61 years old) was admitted to clinic with diagnosis: primary multiple metachronous cancer: left kidney cancer cT3aN0M0, prostate cancer cT1bN0M0, neoplasm of the right colon (tubular adenoma with high-grade dysplasia). Comorbidities: coronary heart disease, paroxysmal form of atrial fibrillation, arterial hypertension. The clinic held a multidisciplinary consultation involving an oncologist, a coloproctologist, an urologist, a radiologist, a chemotherapist, an anesthesiologist, a cardiologist, and a rehabilitation specialist. Simultaneous laparoscopic prostatectomy, nephrectomy, and right hemicolectomy were performed. The patient was managed according to the standard protocols of the rapid recovery program. Distinctive feature of the patient we observed was that the kidney tumor was detected 8 years ago during an outpatient examination, although we could not confirm this fact documented. Since the association between renal cell carcinoma and the risk of developing other malignant tumors has been shown in the literature, we can assume with high probability that patients with renal cell carcinoma have an increased risk of developing a subsequent primary malignancy.

Background: Recurrent postoperative perineal hernia is a rare complication of such operation as posterior pelvic evisceration. This condition can reduce the quality of life in the postoperative period and requires surgical restoration of the impaired pelvic anatomy.Clinical case: A 54-year old female patient applied to the MSU University clinic in July 2020 with the protrusion in the perineal area. She was diagnosed with recurrent perineal postoperative hernia. She was diagnosed with rectal cancer T4N1M0 and uterine dysplasia in 2017, 6 courses of neoadjuvant polychemoradiation therapy were performed; she underwent extralevator abdominal-perineal resection with uterine extirpation and the permanent colostomy formation in 2018. A perineal postoperative hernia was diagnosed in March 2020, perineal transabdominal plastic surgery was performed with a mesh implant. A recurrent perineal hernia was diagnosed in April 2020, the patient underwent laparoscopic alloplasty with a composite mesh implant. On the 9th postoperative day, she was discharged in a satisfactory condition without any complaints.Conclusion: Postoperative perineal hernia is a fairly rare complication in surgical practice. The recurrent rate is quite high. The insufficient number of patients, the short follow-up period and the wide range of surgical treatment methods do not allow evaluating the results adequately. It is necessary to conduct large randomized clinical trials to assess the efficacy of surgical interventions and to determine the indications for certain procedures.

: laparoscopic antireflux surgery are becoming more frequent tool in the treatment of gastroesophageal reflux disease (GERD). In this case, according to the literature, symptoms of dysphagia in the postoperative period arise again in 3-30% of patients, which leads to the fact that 3-6% of them are operated repeatedly. The aim of research : assessment mechanisms for recurrence of GERD and the ability to perform adequate surgical correction after primary antireflux surgery. Materials and methods : the team of authors during the period from 1993 to 2018 operated on 2,678 patients for GERD and hernia of the esophageal aperture of the diaphragm (GVAP). 127 (4.74%) patients underwent surgery for recurrent form of the disease, 46 from their initial operation is performed in other clinics. Results : the median follow-up of re-operated patients was 63 months (12 to 139 months). A satisfactory functional result was achieved in 76.4% of the reopened patients.

: ventral hernias remain one of the most frequent reason for scheduled and emergency surgeries. Despite the widespread use of various methods and technologies of hernias repair, including traditional non-invasive and laparoscopic methods popular in recent years, the problem of recurrent hernias remains relevant to this day. At the end of the last century, studies have shown that patients with inguinal hernias, compared with patients operated on for other intraabdominal reasons, have pronounced quantitative and qualitative changes in collagen proteins. This, in turn, led to increased interest in the exchange of connective tissue and the structure of the extracellular matrix in patients with hernia disease and other similar diseases, as well as the biology of wound healing and scar formation to this day. Significant number of experimental and clinical studies of the structure and function of the extracellular matrix in patients with hernia disease have been accumulated. The review is designed to reveal current understanding of relationships of metabolism of connective tissues and structure of extracellular matrix to pathogenesis of ventral hernias in order to identify key points, which will, in the future, develop a personalized approach to treatment of patients with these disorders.

Background: A high worldwide incidence of colorectal cancer defines the importance of search not only for effective treatment methods, but also for risk factors for the cancer development and its worst prognosis. The influence of many genetic factors, environmental characteristics and lifestyle features has already been proven, and recently the attention of researchers is being focused on the study of microbiota and, in particular, various parasitic intestinal diseases in the context of risk factors for colorectal cancer.Clinical case presentation: we demonstrate an incidental finding of parasitic invasion signs during the pathomorphological examination of the surgical specimen in a patient without an epidemiological history.Conclusion: Further studies are needed not only to confirm and substantiate the role of micro- and macroorganisms inhabiting the intestine in the development of oncological diseases, but also to identify individual links of pathogenesis, pathological pathways and signaling molecules involved in carcinogenesis. Research like this could help broaden knowledge about both the risk factors and predictors of colorectal cancer and the potential sites for targeted therapy.

A mathematical model is developed for the blood flow in the vessels connected with the hepatic portal vein. A satisfactory anatomical model of the venous vessels of unpaired organs in the abdominal cavity and in the portal vein basin is constructed and integrated into the general systemic circulation model. Computer experiments are carried out modeling redistribution of venous and arterial blood flows in the presence of portal hypertension in liver fibrosis. The hydrodynamic properties of the blood flow are investigated allowing for anatomical and artificial shuts and their effect on pressure reduction in the portal vein. The calculation results are consistent with clinical data.

AIM:To evaluate safety of early closure of ileostomy in patients with rectal cancer after primary surgery.MATERIAL AND METHODS:The trial included patients from several medical centers without signs of anastomotic leakage. CT-proctography or rectoscopy were performed in 8 days after primary surgery to confirm integrity of the anastomoses. Exclusion criteria were factors affecting normal tissue regeneration (diabetes mellitus, steroid drugs prescription, etc.). Patients with intact anastomoses and no exclusion criteria were randomized into 2 groups: group 1 (n=31) with early closure of ileostomy (in 8-13 days after surgery) and group 2 (n=34) with delayed closure (after 12 weeks). All data were analyzed.RESULTS:Postoperative morbidity was similar in both groups (6.45% vs. 5.88%, p=0.08). However, less duration of reconstructive surgery was noted in group 1 (50 (27-126) min vs. 71 min (31-134). This value was 1.42 times less in the main group (95% CI 1.30-1.52; p=0.02).CONCLUSION:Early closure of ileostomy in patients after surgery for rectal cancer is feasible and does not result increased postoperative morbidity. This approach may be considered as an alternative to delayed closure. However, further researches devoted to analysis of ileostomy-associated complications and quality of life are necessary.