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Effectiveness of artificial intelligence's system ArtInCol in diagnostic of colorectal neoplasia during colonoscopy: results of multicenter randomised clinical trial
AIM: to evaluate the effectiveness of the Russian artificial intelligence system ArtInCol during routine colonoscopy. PATIENTS AND METHODS: from August to December 2024 a multicenter randomized trial was done and included 4 medical institutions and 1,128 patients. The patients were randomized into colonoscopy groups without AI (n = 547) and colonoscopy group using the ArtInCol artificial intelligence system (n = 581). The data was analyzed according to the “intention-to-treat” and «per protocol» types, with the primary endpoint being the frequency of detection of adenomas. RESULTS: the randomized groups were homogenous in all analyzed variables. When comparing the primary end-point, the detection rate of adenomas (ADR) in the studied group of AI-assisted colonoscopy was 47.2% (95% CI: 43.1–51.2), compared with 41.3% (95% CI: 37.3–45.5) without AI, the effect value was 5.9%, p = 0.048. The average number of detected adenomas was 0.97 (95% CI: 0.85–1.09), versus 0.79 (95% CI: 0.67–0.92) in the control group, which is a statistically significant difference (p = 0.01). CONCLUSION: the study confirm the hypothesis of the effectiveness of the AI — ArtInCol system in order to improve the quality of neoplasm detection during colonoscopy. An increase in the detection rate of adenomas by 5.9% was recorded.
Chronic anal fissure treatment using lateral internal sphincterotomy without excision: prospective randomized study (NCT05117697)
AIM: to assess the outcomes of chronic anal fissure treatment using lateral internal sphincterotomy with and without fissure excision. PATIENTS AND METHODS: a prospective, single-center, randomized study included 107 patients with chronic anal fissure (CAF) older than 18 years, without severe comorbidities, rectal fistulas, grade 3–4 hemorrhoids, or clinical manifestations of anal sphincter insufficiency (ASI) from October 2021 to October 2023. Patients were randomized using a random number generator into two groups: 56 patients in the main group underwent lateral internal sphincterotomy (LIS), and 51 patients in the control group underwent LIS combined with fissure excision (LIS + FE). Immediate results were analyzed per protocol in 50 patients per group. Late outcomes were assessed in 44 patients in the main group and 43 patients in the control group. Primary endpoint: epithelialization of the defect on the 60th day after surgery. Secondary endpoints: epithelialization of the defect on the 15th, 30th, and 45th days postoperatively, incidence and structure of complications, pain syndrome (VAS from day 1 to day 60), profilometry indicators on the 30th, 60th, and 365th days postoperatively, time of temporary disability, incidence of ASI on the 30th, 60th, and 365th days postoperatively (Wexner's scale), and recurrence rate. RESULTS: by day 60, the anal fissure had epithelialized in 47/50 (94%) patients in the main group, while the postoperative wound had healed in 48/50 (96%) patients in the control group (p = 1). On days 15, 30, and 45, the epithelialization rate of the anal fissure was significantly higher than that of the postoperative wound. Fissure excision increased the likelihood of an unhealed postoperative wound on day 30 (OR 18.7 95% CI: 5.8–60.4; p < 0.0001) and on day 45 (OR 5.23 95% CI: 1.97–13.8; p = 0.0008). In the main group, post-defecation pain intensity was significantly lower than in the control group during the first 30 days (p < 0.0001). On the 30th postoperative day, gas incontinence was reported by 9/50 (18.0%) patients in the main group and 17/50 (34%) in the control group (p = 0.1), while on the 60th day, 2/50 (4.0%) patients in the LIS group and 3/50 (6%) in the LIS + FE group (p = 1.0) reported gas incontinence. The median Wexner score on the 30th postoperative day was 1 (1; 1) in the LIS group and 2 (1; 3) in the LIS + FE group (p = 0.03). Univariate analysis showed that factors increasing the likelihood of anal incontinence on the 30th postoperative day were age (OR = 1.03; 95% CI: 1.0–1.07) and childbirth history (OR = 12.3; 95% CI: 1.3–118.3). Fissure excision had a greater negative impact on patients' quality of life in the early postoperative period. The median Hemo-Fiss score on the 30th postoperative day was 5.5 (0; 13) points in the main group and 11 (5; 20) points in the control group (p = 0.02). The median time of temporary disability was 9 (6; 11) days in the LIS group and 15.5 (12; 23) days in the LIS + FE group (p = 0.0006). In the long-term postoperative period (up to 1 year), the groups were fully comparable in complication rates and nature. Recurrence occurred in 1/44 (2.2%) patients in the main group and 2/43 (4.6%) patients in the control group (p = 1.0). A rectal fistula was identified in 2/44 (4.5%) patients in the main group and 1/43 (2.6%) in the control group. ASI was observed only in the control group in 1/43 (2.3%) patients. Profilometry measurements showed that maximum resting anal canal pressure was 102 (89; 111) mmHg in the main group and 96 (85; 112) mmHg in the control group (p = 0.08). The mean resting anal canal pressure was 55 (52; 59) mmHg in the LIS group and 52 (42; 58) mmHg in the LIS + FE group (p = 0.1). CONCLUSION: performing LIS without fissure excision prevents long-healing wound in the anal canal, reduces pain intensity, decreases the severity of anal incontinence, improves quality of life, and shortens temporary disability. Avoiding fissure excision does not lead to worsening of late outcomes.
Results of chronic anal fissure treatment with botulinum toxin type A at a dose (dosage) of 80 units without its incision (single-center prospective randomized controlled trial NCT05598164)
AIM: to assess efficacy of botulinum toxin type A (BTA) at a dosage of 80 units for chronic anal fissure (CAF) without excision. PATIENTS AND METHODS: single-center prospective randomized controlled trial (NCT05598164) was held between September 2022 and December 2024 in order to compare isolated usage of BTA (main group) at a dosage of 80 units with its combination with excision of the fissure — BTA + EF (control group) for CAF. One hundred sixty-seven were randomized — 86 were included in main group and 81 — in control one. After application of exclusion criteria 126 patients were included in final analysis: 65 in group of BTA only and 61 in group of its combination with EF. Control examination, pain syndrome intensity according to visual-analogue scale (VAS), profilometry and assessment of transitory anal incontinence according to Wexner scale were done in pre- and postoperative period. The primary endpoint was epithelization of defect (for the main group) or postoperative wound (for the control group) on 60th day after surgery. RESULTS: on the 60th day postoperative defect healed in 46/59 (78.0%; 95% confidence interval (CI): 65.2–87.7) patients in main group vs. 34/50 (68.0%; 95% CI: 53.3 — 80.5) patients for postoperative wound in control group (р = 0.3). At the same time, on the 15th day defect healed in 12/65 (18.4%) patients in BTA group, whereas no one's postoperative wound healed in group BTA + EF (р = 0.0003); on the 30th day — in 18/59 (30.5%) vs. 1/53 (1.9%) patients(р < 0,0001); on the 45th day — in 31/57 (54.4%) vs. 3/52 (5.8%) patients(р < 0.0001). The rate of postoperative complications was 23/65 (35.4%) in main group and 23/61 (37.7%) in controls (р = 0.8). On the 30th day transitory anal incontinence was detected in 15/60 (25.0%) patients in BTA group and in 18/53 (34.0%) in combinations of its injection with EF (p = 0.3); on the 60th day — in 7/60 (11.7%) and 9/51 (17.6%) patients (p = 0.4); external hemorrhoids thrombosis developed in 2/65 (3.1%) patients of main group and in 2/61 (3.3%) of control group (p = 1.0); intrasphincter fistula — in 5/60 (8.3%) and 3/50 (6.0%) patients (p = 0.7). Intensity of pain syndrome during the day and while defecation began to decrease in patients of main group from the 1st day after surgery, whereas it increased and returned to pre-operative level in control group by the 3d day, where remained till the 9th day, only after this it decreased. Significant differences between groups were revealed to 48–49th days. According to profilometry, spasm of internal anal sphincter (IAS) remained in 22/56 patients of main group and in 16/52 patients of control group; on 60th day — in 22/52 (39.3%) and 8/50 (16.0%) patients relatively (p = 0.004). In group of BTA there were statistically significantly fewer days of disability than in group of combination BTA with EF — 7 (6; 15) vs. 20 (15; 30) days. Method of treatment BTA + EF became significant factor, increasing chances of no epithelization on the 30th (odds ratio (OR) = 22.8; 95% CI: 2.93–178.0; р = 0.003) and 45th (OR = 19.5; 95% CI: 5.43–69.8; р < 0.0001) days. On the 60th day presence of IAS spasm was statistically significantly associated with non-healing (OR = 2.68; 95% CI: 1.08–6.66; р = 0.034). The factors which could influence the existence of transitory anal incontinence, were not detected. CONCLUSION: refusal from EF while BTA's use at a dosage of 80 units allows to achieve defect epithelization on early post-operative period, lower intensity of pain syndrome and significantly decrease time of temporary disability.
The course of complicated Crohn's disease during therapy with Russian biosimilars of infliximab and adalimumab
AIM: to assess the course of complicated forms of CD against the background of therapy with Russian biosimilars of infliximab and adalimumab, as well as the survival rate of therapy in this group. PATIENTS AND METHODS: a retrospective evaluation of patients with complicated CD who received infliximab or adalimumab with follow up at the institution for at least three consecutive years was performed. A total of 15 patients with complicated CD received infliximab therapy and 14 received adalimumab. The main clinical and demographic parameters and the rate of of intra-abdominal complications during 3 years of follow up of patients were analyzed. RESULTS: in the infliximab group, a decrease in the rate of stenosis was noted during 3 years of follow up (from 12/15 (80%) to 3/6 (50%)), the rate of detection of other complications did not change, in addition, during the specified period, resection was performed in all patients in this subgroup. The median survival of therapy in this group was 11 (8.5; 24) months. In the adalimumab group, all 6 patients followed up showed resolution of stenosis at the beginning of the third year of therapy, while over the course of two years, the frequency of their detection remained the same as before the start of treatment. By the end of the 1st year of therapy, complete resolution of paraintestinal infiltrates was noted. During three years of observation, only 1 patient underwent resection, the median survival of therapy was 20.5 (14–24) months. CONCLUSION: the study obviously has a number of limitations typical for a retrospective analysis of small samples. However, there is a decrease in the incidence of complications with infliximab or adalimumab therapy. There is a need for a well-designed prospective study on the dynamics of intra-abdominal complications in patients with CD against the background of GEBD.
Predictors of rectovaginal fistula recurrence in patients with Crohn's disease
AIM: to determine the risk factors rectovaginal fistula (RVF) recurrence in patients with CD. PATIENTS AND METHODS: a retrospective analysis included 60 patients with perianal fistulizing Crohn disease and rectovaginal fistulas (2016–2024). In order to identify the risk factors of RVF recurrence, the clinical and history data of 28 patients who underwent radical treatment for RVF were collected and analyzed. RESULTS: the follow-up period for the patients after surgery was 3–12 moths. According to clinical and instrumental data, recurrence of the disease occurred in 11/28 (39%) females. Multifactorial analysis showed increase the likeli-hood of RVF recurrence was the avoid of a loose seton at the first stage (odds ratio (ОR) = 27.49; 95% confidence interval (CI): 2.02–374.8; p = 0.013). Absence of biological therapy to treat Crohn's disease (ОR = 15.77; 95% CI: 1.13–220.4; p = 0.04) reduces the incidence of RVF recurrence as well. CONCLUSION: patients with RVF represent the most challenging cohort of patients with perianal fistulizing Crohn disease (PFCD) due the significant recurrence rate, however combined two-step approach and careful assessment of risk factors before surgery improve the results.
Controlled laser sphincterotomy for anal fissure
AIM: to evaluate original method to relieve spasm of the sphincter for surgery of chronic anal fissure. PATIENTS AND METHODS: sixty-six patients with chronic anal fissure with spasm were included in the pilot study. These patients underwent controlled laser sphincterotomy of the internal sphincter with bare tip fiber laser surgery unit IPG “IRE-Polus” with a wavelength of 1.56 µm affecting the whole internal sphincter circumference with the overall energy impact in average 300–400 J. The second stage of treatment was standard fissure excision in the longitudinal direction with further suturing of the wound in the same direction. In the end, 1.5–2 ml of plateletrich plasma was injected under the sutured wound. Before and 1 month after the surgery all the patients underwent sphincterometry. RESULTS: all the patients showed increased anal sphincter tone before surgery. After the use of the original method, the sphincter tone of 63 patients (95.5%) has returned to normal, no pain syndrome developed. Since the spasm still took place in 3 cases (4.5%), controlled laser sphincterotomy was used within few days after surgical treatment, and as a result the spasm was adequately removed. In 2 (3.0%) cases transient gases incontinence was noted, which disappeared by itself within one month after operation. Thirteen (19.7%) patients had complications, not connected to the controlled laser sphincterotomy. In 9 cases complications were connected with suturing of the wound (ligature fistula and wound dehiscence.) In 4 cases long-term non-healing wounds were revealed, complete healing in these cases took 104.0 days. The complete healing of 62 patients, not taking into account these 4 cases with long-term non-healing wounds was 29.6 days. CONCLUSION: the original method is safe, quite effective, and the digital value of energy which affects sphincter makes it possible to control it. The further study is needed.
AIM: to assess risk factors for bowel cancer associated with Crohn's disease, as well as to assess the clinical features of the combined pathologies. PATIENTS AND METHODS: retrospective study included 1,478 medical records of patients with Crohn's disease in 2020–2024. Eleven patients with bowel cancer were identified. RESULTS: history analysis revealed that colorectal cancer developed mainly in patients with a long history of the CD, in whom inflammatory changes in the intestine were detected at a young age, and complications of the disease were noted as well (fistulas, strictures, perianal manifestations). For CD, patients received therapy with various genetically engineered biological agents. When colorectal cancer was detected, the tumor was localized in the colon or rectum, and had the histological structure of adenocarcinoma. After treatment (neoadjuvant chemoradiation therapy, adjuvant chemotherapy, surgery), patients were followed up for 0–16 months, during this period, relapses of Crohn's disease and colorectal cancer were not detected. CONCLUSION: further studies are needed to assess the risk factors for the development of bowel cancer in the presence of Crohn's disease, the characteristics of the course of Crohn's disease after diagnosed bowel cancer, and the development of approaches to the diagnosis, treatment, and prevention of such conditions.
Late results of combined rectovaginal septum plastic surgery using a mesh in patients with low rectocele
AIM: to evaluate the functional results of combined rectovaginal septum plastic surgery using a mesh in patients with low rectocele grade 2–3 three years after surgery. PATIENTS AND METHODS: a single-center prospective observational study included 40 patients with isolated low anterior rectocele of grade 2–3 and complaints of the need for manual assistance during defecation (2012–2019). The median age was 56.5 (51; 60) years. The second degree of the disease was noted in 30/40 (75%; 95% CI: 57.3–87%), the third — in 10/40 women (25%; 95% CI: 8.1–55.8%). Preoperative defecography proved the presence of a saccular protrusion in the low third of the vagina and perineal descending syndrome in all patients, excluded signs of internal rectal intussusception and puborectal muscle spesm. In order to correct the low rectocele, transvaginal combined plastic surgery of the rectovaginal septum was performed using a mesh implant protected from contact with the vaginal mucosa by sutured levators. To assess the functional results of the surgery, the Cleveland Constipation Scale (Wexner), the SF-36 questionnaire, and the "Questionnaire for Assessing the Quality of Life in Rectal Surgeries" were used before and 3 years after the surgery. RESULTS: three years after surgery, the low rectocele recurrence developed in 2/40 (5.0%; 95% CI: 1.4–16.5%) patients, while none complained of the need for manual assistance when emptying the rectum. Rectocele was not detected in 38/40 (95%) women (p < 0.001) by defecography, while in 2 patients with recurrence, the rectocele depth was 20 mm and 22 mm, and the position of the anorectal zone in straining decreased from 30 (30; 34.8) mm to 20 (10; 30) mm (p < 0.001). The intensity of bowel movement disorders according to the Cleveland Constipation Scale (Wexner's) decreased from 10 (7; 13) points to 5.5 (3; 7) (p < 0.001). After 3 years, an increase was noted in both the indicators of the physical and psychological health components of the SF-36 questionnaire to 47.9 (42.4; 52.7) and 53.2 (44.8; 58) points, respectively (p < 0.001), as well as all 8 scales of the “Questionnaire for Assessing the Quality of Life in Rectal Surgeries” (p < 0.001). CONCLUSION: combined plastic surgery of the rectovaginal septum with a mesh implant protected from contact with the vaginal mucosa by sutured levator muscles for low rectocele grades 2-3 only, leads to the elimination of manual assistance need in defecation, a decrease in the severity of constipation, and an improvement in the quality of life.
Microbiota and rational empirical antibacterial therapy of anorectal abscess
AIM: to characterize the microbiota composition of anorectal abscess and determine the optimal empirical antibiotic therapy strategy based on microbial culture data with antibiotic susceptibility testing. PATIENTS AND METHODS: following incision and drainage of an anorectal abscess in 149 patients, samples of wound exudate were collected from postoperative wounds by swab method and subjected to bacteriological analysis. In 102 cases, only monocultures were isolated, and in 10 cases, the association of two microorganisms was observed. The absence of microbial growth was noted in 37 cases. RESULTS: among the identified microorganisms, the most prevalent were Escherichia coli (51.68%), Klebsiella pneumoniae (12.75%), and Staphylococcus aureus (7.38%). Less frequently encountered pathogens included Enterococcus faecalis (6.04%), Enterobacter cloacae (3.36%), and Pseudomonas aeruginosa (3.36%). The assessment of the isolated microorganisms' susceptibility to a range of antibiotics allowed us to determine the weighted average efficacy of each drug against the microbiota identified. CONCLUSION: the combination of ciprofloxacin and clindamycin demonstrated high clinical and economic efficacy, making it a preferred empirical therapy in patients with severe form of anorectal abscess.
Search for bacterial biofilms in the chronic anal fissure (descriptive study with in-depth visualization)
AIM: to reveal biofilms in chronic anal fissure (CAF) bacterial composition. PATIENTS AND METHODS: patient A., 40 years old, with chronic posterior and anterior anal fissures with sphincter spasm underwent a lateral subcutaneous sphincterotomy with excision of the CAFs. Before the operation swabs were taken from fissures for microbiology. Removed specimens were placed in fixing solutions. Microbiological studies including 16S rRNA gene sequencing and MALDI-ToF mass spectrometry of isolated cultures were carried out to assess the bacterial composition of CAFs. Microscopic studies which included scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to search for the biofilm location of microorganisms. Conclusions about the presence of biofilms were made during the comparison of photographs with reliable images described in the literature. RESULTS: a wide variety of bacteria (56 genera) was detected in the tissues forming the CAF based on sequencing of 16S rRNA genes; swab's mass spectrometry revealed only E. coli and P. anaerobius in significant concentrations. Using SEM on one of the sections of the excised CAF were found biofilms containing bacterial cells immersed in an extracellular matrix (which size was within the limits of 2 microns); similar structures weren't detected outside the CAF. On TEM an accumulation of bacterial cells, surrounded by an extracellular polymer matrix, what was interpreted as a biofilm of gram-negative bacteria, was identified. After 7 months, the patient retained a non-healing postoperative wound in the area of the previously excised posterior fissure. After repeated sowing, E. coli and S. gallolyticus were obtained in significant concentrations. Excision of the scarred edges of the wound and the prescribed conservative treatment allowed the wound to epithelize within 3 weeks. CONCLUSION: the results show that microbial biofilms can be localized in the CAF. Further researches are needed for reliable conclusions about biofilm organization in CAF and their effect on pathological and reparative processes.
The effect of the timing of the elimination of preventive ileostomy on the incidence of severe low anterior resection syndrome
AIM: to study the effect of early ileostomy closure on the incidence of low anterior resection syndrome (LARS) in patients with rectal cancer. PATIENTS AND METHODS: one-hundred patients with rectal cancer underwent radiation therapy with a total focal dose of 50-54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The primary endpoint of the study was the incidence of significant anorectal dysfunction at 3 months after ileostomy closure. Secondary endpoints included the incidence and severity of clinical manifestations of anorectal dysfunction, anal incontinence score according to the Wexner scale, overall distribution of anorectal dysfunction (absent, mild, severe) and the incidence of postoperative complications. Patients were randomized into two groups: with early ileostomy closure within 6 (5; 7) weeks after low anterior rectal resection (50 patients) and with late ileostomy closure after 24.5 (20; 29) weeks (50 patients). Three months after ileostomy closure, a questionnaire was done using the LARS and Wexner scales. RESULTS OF THE STUDY: the results obtained at 3 months after ileostomy closure showed advantages of the early ileostomy closure group. According to the GIFO scale, clinical manifestations of anorectal dysfunction were significantly less common in this group (p < 0.05). According to the LARS scale, the incidence of anorectal dysfunction in the early ileostomy closure group was 40%, while in the late closure group it was 70% (OR (odds ratio) = 3.50; 95% CI (confidence interval): 1.49–8.23; p = 0.0046). Moreover, severe LARS was detected in 6% and 26% of patients, respectively (OR = 0.12; 95% CI: 0.03–0.43; p = 0.012). The Wexner scale score was also significantly better in the early closure group (5 (4; 8) points) compared to the late closure group (9 (8; 10) points, p < 0.0001). With regard to the complications that developed in the late ileostomy closure group, a significantly higher incidence of colitis was noted (21/50 (42%) versus 6/50 (12%) cases, p = 0.0014). CONCLUSION: in the course of the conducted work it was established that 3 months after ileostomy closure, patients in the early closure group showed less manifestations of anorectal dysfunction compared to patients in the late closure group.
Relationship of dyslipoproteinemia features with arterial stiffness in young and middle-aged patients with ulcerative colitis
AIM: to study the features of dyslipoproteinemia and vascular wall elasticity in young and middle-aged patients with ulcerative colitis (UC). PATIENTS AND METHODS: the work was carried in the period from January 2021 to January 2025. The first stage included a retrospective and prospective analysis of 495 medical records of patients with UC, of which: 48 patients (group I) in the debut of UC with a UC activity index (Mayo index) of 6–9 points; 401 patients (Group II) from the regional registry of patients with IBD with a history of UC up to 10 years inclusive, with a moderate to severe course of the disease and who did not receive targeted immunosuppressants and genetically engineered biological drugs (GIBPS) until the time of retrospective analysis; 46 patients with UC (group III) with a disease duration of up to 5 years inclusive and who used in the anamnesis of GIBP (vedolizumab, infliximab, ustekinumab). As part of the second stage of the study, 3 study groups (I-1, I-2, and I-3) and a control group (K) were formed. The I-1 group included 40 patients from group I, the I-2 group included 80 patients from group II, and the I-3 group included 31 patients from group III, with a duration of UC of 5 years, in whom the appointment of biological therapy occurred in the first year after the manifestation of UC. The I-2 and I-3 groups included patients in clinical remission for at least 3 months before being included in the study. The I-2 group included 39 patients with a duration of UC up to 5 years inclusive (I-2.1) and 41 patients with a duration of UC 6–10 years inclusive (I-2.2). 160 people from practically healthy individuals who had no clinical or endoscopic signs of UC were selected for the control group K. The study included people under the age of 60. All study participants underwent a lipid profile study, volumetric sphygmography with determination of the cardiovascular vascular index CAVI (Cardio-Ankle Vascular Index). RESULTS: аs a result of the study, specific quantitative features of the components of the lipid profile in patients with UC were revealed, consisting in a lower level of atherogenic components: total cholesterol, low-density lipoprotein cholesterol (p < 0.001), against a background of a relatively higher amount of triglycerides ((p < 0.01), and low levels of high-density lipoprotein cholesterol (p < 0.001), as well as a higher atherogenicity index (p < 0.01), especially when the inflammatory process in the intestine is activated. When measuring the CAVI index, higher values of this indicator were recorded in the study groups than in the participants of the control group (p < 0.001). The maximum deviation of the CAVI index was found in the I-2.2 group (Me — 1.32, Q1–Q3: 1.06–1.58, rI-2.2 — K < 0.001), which included patients with UC experience from 6 to 10 years. CONCLUSION: the quantitative features of the lipid profile revealed during the study suggest the presence of special changes in the biochemistry of all lipid fractions in UC and possibly a higher need for them during the development of IBD. Further study of the biochemistry of lipoproteins and their genetic determination in patients with IBD is necessary.
Superabsorbent dressings with a contact layer of silicone in patients after surgery for pilonidal disease (results of a randomized trial)
AIM: to assess surgical results in patients with pilonidal disease with purulent fistula using postoperative superabsorbent dressings. PATIENTS AND METHODS: the prospective randomized study included 121 patients with pilonidal disease in the stage of purulent fistula, who underwent surgery (excision of the epithelial coccygeal tract with fixation of the skin edges to the sacrococcygeal fascia). In group I patients (n = 58), silicone-based dressings were used. In group II patients (n = 63), traditional dressings were used. The follow up was 2 months. The assessment included pain syndrome on days 3, 6 and 9 of the postoperative period, the presence of skin damage, the presence of subjective complaints of itching, burning, discomfort in the area of the dressing, the number of postoperative complications in the form of suppuration of the postoperative wound, dehiscence of the fasciocutaneous sutures. RESULTS: silicone-based superabsorbent patch-type dressings decreased unsatisfactory skin condition from 20 cases in the control group to 2, the pain syndrome was lower than when using adhesive-based dressings and was 1.3 ± 0.4 and 3.8 ± 0.8 points respectively. There was also a decrease in the number of postoperative complications from 20.6% to 10.3% in the comparison groups. CONCLUSION: superabsorbent patch-type silicone-based dressings improve the subjective sensations of patients, have less impact on the skin and wound surface, make removal of dressing material easier and reduce the number of postoperative complications.
Active surveillance program of patients with rectal cancer with a complete clinical response after prolonged chemoradiotherapy with consolidating chemotherapy
AIM: to determine the algorithm for selecting patients included in the ASP program after prolonged chemoradiotherapy (CRT) with consolidation chemotherapy (CCT). PATIENTS AND METHODS: the retrospective study included patients with adenocarcinoma of the low and middle rectum (2017 to 2024), who achieved cCR after CRT with CCT, which led to the decision to implement ASP. Radiotherapy was administered in a prolonged mode at a dose of 50–55 Gy with oral capecitabine intake. Between the completion of CRT and the first follow-up examination, 4 cycles of CCT were done in the FOLFOX6 regimen. Clinical tumor regression was assessed 4 weeks after the completion of CCT, based on the data from endoscopy, digital examination, and MRI. cCR was understood to refer to cases where, during endoscopic treatment performed after CRT and CCT at the site of the previously determined tumor, there were signs of a flat white/red scar. RESULTS: the study included 27 patients (15 (55.6%) men, 12 (44.4%) women). The patients' age ranged from 38 to 80 years (median 63 years). The median distance from the anal verge to the lower edge of the tumor was 4.5 (2.0–9.5) cm. Most patients had clinical stage III disease — 18/27 (66.7%), while the tumor size in the largest dimension ranged from 2.4 to 6.5 cm (median 4.0 cm). The median interval between the completion of CRT and the follow-up examination was 16 (9–25) weeks. MRI of the pelvic organs revealed TRG1 in 13/27 (48.1%) patients, TRG2 also in 13/27 (48.1%) and in one patient (3.7%) has a mucinous tumor that is not subject to standard TRG assessment. The MRI findings of all patients selected for ASP was characterized by fibrosis of the tumor bed without signs of residual tumor tissue/affected lymph nodes in the mesorectal tissue and deep layers of the wall, while both thin and full-thickness and split fibrous scars present, extending up to half the circumference. All patients who achieved cCR had a primary tumor of category up to T3b inclusive. With a median follow-up of 14.7 (3.8–80.2) months, tumor regrowth was observed in 2/27 patients (7.4%), both of whom underwent radical surgeries. Three-year relapse-free survival rate was 81.1 ± 10.1%, while overall survival 95.2 ± 4.6%. CONCLUSIONS: the implementation of an ASP program after CRT should be based on careful selection of patients who have achieved cCR according to comprehensive check-up. It is advisable to begin the examination with MRI followed by endoscopy, as this approach provides all necessary information and avoids artifacts in MRI that may arise after endoscopy. Endoscopy plays a leading role in assessing the intraluminal tumor component, with the only manifestation of cCR being a flat white or red scar.
Physiotherapeutic effects of Er:YAG and Nd:YAG lasers in acute hemorrhoids
OBJECTIVE: to evaluate the effectiveness of nonsurgical treatment of thrombosed external hemorrhoids using a non-ablative erbium and neodymium laser. PATIENTS AND METHODS a retrospective study included 14 females with thrombosed external hemorrhoids with severe pain, who was underwent a single procedure of perianal area irradiation with a non-ablative erbium and neodymium laser in PIANO mode. RESULTS: the assessment of pain using a visual analog scale directly after the 15-minute procedure decreased from 8 (7; 10) до 1 (0; 2) points of VAS (р < 0,001). The severity of defecation pain was reduced over a week from 8 (7; 10) до 0 (0; 2) points of VAS (р < 0,001). One week after treatment, no pain occurred. No complications or symptom deterioration developed during the follow-up. No patients showed recurrence for six months follow up. CONCLUSION: a single procedure of combined exposure to a non-ablative erbium and neodymium laser on the perianal area in patients with thrombosed external hemorrhoids effectively alleviates pain syndrome and promotes rapid symptoms regression, thereby avoiding surgical treatment and its associated long postoperative care and risk of complications.
Comments on the article Physiotherapeutic effects of Er:YAG and Nd:YAG lasers in acute hemorrhoids, authors: Olga A. Pustotina, Anna V. Lopatina, Zdenko Vizintin
Clinical and laboratory predictors of postoperative infectious complications in patients with colorectal cancer
AIM: to determine the prognostic significance of clinical and laboratory parameters in the diagnosis of postoperative infectious complications in patients with colorectal cancer. PATIENTS AND METHODS: the retrospective single-center study included patients who underwent elective radical surgery for newly diagnosed colorectal cancer with the formation of a primary anastomosis in the period from 2016 to 2024. The endpoints of the study were to determine predictors of the development of infectious complications in the early postoperative period and compare the preoperative level of inflammatory markers in the group with and without infectious complications. The logistic regression model included demographic and clinical and laboratory parameters, including complex indicators NLR (neutrophil-lymphocyte ratio), PLR (platelet-lymphocyte ratio), SII (systemic immune-inflammation index), SIRI (systemic inflammation response index). The significance of the influence of predictors on the risk of complications was assessed using the odds ratio (OR), 95% confidence interval (CI), and significance level (p-value). RESULTS: a total of 381 patients were included in the analysis, of which 43 (11.3%) patients with infectious complications and 338 (88.7%) patients without infectious complications. Patients with postoperative infectious complications were more likely to have cT3-4 tumor (86.0% vs. 68.6%, p = 0.018), as well as higher leukocyte levels (6.5 × 109/l, IQR (Interquartile Range) 5.2–8.2 vs. 6.8 × 109/l, IQR 6.0–8.4, p = 0.002), NLR (208.0, IQR 119.0–217.0 vs. 208.0, IQR 123.0–306.0, p = 0.007), SII (578.9, IQR 385.8–939.3 vs. 765.9, IQR 457.8–1463.6, p = 0.004), SIRI (1.2, IQR 0.8–2.0 vs. 1.7, IQR 1.0–2.9, p = 0.006). Based on the results of a univariate logistic regression analysis, the following predictors of the development of infectious complications in the early postoperative period were determined: stage cT3-4 (OR 2.82, 95% CI 1.15–6.88, p = 0.02), NLR (OR 1.06, 95% CI 1.01–1.13, p = 0.03), PLR (OR 1.002, 95% CI 1.001–1.003, p = 0.04), SII (OR 1.0003, 95% CI 1.00006–1.0004, p = 0.01) and SIRI (OR 1.04, 95% CI 1–1,09, p = 0.05). According to the results of a multivariate analysis, the independent predictors of infectious complications were the stage cT3-4 (OR 2.82, 95% CI (1.15–6.88), p = 0.02) and SII (OR 1.0003, 95% CI (1.00006–1.0004) p = 0.01). The sensitivity of the proposed model was 71.8% (95% CI 63.2–80.4%), specificity was 63.5% (95% CI 57.2–69.8%), AUC = 0.671, (95% CI 0.635–0.707, p = 0.038). CONCLUSION: the presented prognostic model predicts the likelihood of a patient having an infectious complication in the early postoperative period.
Extra- and intracorporeal anastomosis in right hemicolectomy (observational cohort study)
AIM: to compare intracorporeal and extracorporeal anastomosis in right hemicolectomy in patients with CRC. PATIENTS AND METHODS: observational cohort study included 296 patients with colorectal cancer who underwent elective right hemicolectomy with ileo-transversal anastomosis (2023-2024). Patients were divided into two groups: extracorporeal (ECA) and intracorporeal (ICA) The primary endpoint was the rate and severity of postoperative complications by Clavien-Dindo scale, while the secondary endpoints were the time of surgery and hospital stay, gastrointestinal tract recovery time, readmission and postoperative ventral hernia rate. All interventions were performed by surgeons, who are annually performing at least 30 procedures for CRC. RESULTS: extracorporeal group included 226 (76.4%) patients, while 70 (23.6%) — intracorporeal one. The median time of surgery was found to be significantly shorter in the ECA group (185 [150; 223] min) compared to the intracorporeal anastomosis group (200 [185; 240] min) (p < 0.001). The incidence of postoperative morbidity according to the Clavien-Dindo classification did not differ between the groups. Intra-abdominal complications in the ICA group occured in 10% (n = 7/70) of patients, there were no cases of anastomotic leak in this group, while in the ECA group the incidence of intra-abdominal complications were 18.1% (n = 41/226) (p = 0.106), with anastomosis leak rate of 4.0% (n = 9/226). Infection of the surgical site was less in the ICA group — 5.7%, (n = 4/70), than in the ECA group — 15.9%, (n = 38/226) (p = 0.033). The recovery of bowel function was observed earlier in the ICA group: the first stool was observed on 3 [3; 4] days in the ECA group and 3 [2; 3] in the ICA group (p < 0.001); median of the first flatus were 2 [2; 2] and 2 [1; 2] days, respectively (p < 0.001). The length of stay for ICA was shorter than for ECA (5 [3; 6] days vs. 7 [6; 8], p < 0.001). A total of 158/296 (64.8%) patients were examined for incisional hernias. Incisional hernias were only diagnosed in the extracorporeal group, accounting for 54/128 (42.2%) cases. There were no hernias in the intracorporeal group — 0/30. CONCLUSION: intracorporeal anastomosis in right hemicolectomy does not increase the risk of intra-abdominal complications and can be considered a safe alternative to extracorporeal anastomosis, which showed early bowel function recovery and reduction of the risk of wound infection and incisional abdominal hernia.
A linear stapler-free colonic anastomosis for left colectomy: a retrospective comparative study
AIM: to evaluate early outcomes of original colon linear stapler-free anastomosis after left hemicolectomy or sigmoid resection. PATIENTS AND METHODS: a retrospective study included 98 patients, who underwent a laparoscopic left colon resection with anastomosis were included and divided in 2 groups: single stapler (study group) and double stapler (control group) anastomosis. The primary endpoint was anastomotic leakage. Secondary endpoints included surgical morbidity (Clavien-Dindo), operation time, blood loss and hospital stay. RESULTS: thirty-nine patients were included in the study group and 59 in the control group. No cases of anastomotic leakage were observed. Surgical morbidity grade IIIB or higher developed in 0 and 1 (1.7%) patients, accordingly (р = 1.0). Median hospital stay was 8 days (7; 11) and 10 days (7; 11), р = 0.19), median bloodloss 50 ml (50; 70) and 50 ml (50; 100), р = 0.8. Operation time was shorter in the main group 100 min (80; 120) and 120 min (82.5; 155), р = 0.048. CONCLUSIONS: the original anastomosis is safe.
Endoscopic treatment of patients with adenomas of the major papilla of the duodenum in familial adenomatous polyposis
AIM: to evaluate the feasibility of endoscopic techniques in the treatment of patients with adenomas of the major duodenal papilla in familial adenomatous polyposis. PATIENTS AND METHODS: from January 2020 to January 2025, thirteen patients with adenomas of the major duodenal papilla (MDP) suffering from familial adenomatous polyposis (FAP) underwent endoscopic procedures. In seven cases, the adenomas of the major duodenal papilla had exclusively extrapapillary components without involvement of the ducts. Four patients presented with type IV adenomas, while two cases were classified as type III according to the endoscopic classification of benign neoplasms of the MDP. In six instances, there was noted extension of the adenoma to the common bile duct (CBD), and in three cases, the adenoma extended to the walls of the main pancreatic duct (MPD). The study examined the main aspects of MDP neoplasms, including their growth patterns and extent of spread. Additionally, the advantages of endoscopic techniques for removing these neoplasms were discussed, along with intraoperative and postoperative complications arising from the interventions. RESULTS: in all cases, endoscopic removal of adenomas of the MDP was successfully performed. It should be noted that in 7 out of 13 cases (53.8%), when neoplasms of types I and III were present, the adenomas were removed en bloc, while in 6 out of 13 cases (46.2%), fragmentary removal was performed for adenomas of types II and IV. However, complications arose in 3 out of 13 cases (23.1%) after the intervention: two patients developed moderate post-procedural pancreatitis, and one patient experienced bleeding that required endoscopic hemostasis. In 2 out of 13 cases (15.4%), residual adenoma tissue was detected, necessitating repeat endoluminal intervention. It is noteworthy that the complications (bleeding) and recurrences were managed with repeat endoscopic procedures without the need for high-trauma surgical operations. CONCLUSION: the study demonstrated the feasibility of endoscopic procedures for the treatment of patients with adenomas of the MDP against the background of FAP.
Autoamputation of a sigmoid colon giant lipoma (a case report)
Patient B., a 62-year-old man, with giant benign tumor and obstruction of the sigmoid colon presented. The elective surgery was canceled due to autoamputation of the tumor, which passed without complications and was confirmed by another colonoscopy. Pathohistological study confirmed the lipoma. Autoamputation of a colon lipoma is extremely rare and usually occurs in giant tumors.
Advantages and disadvantages of laparoscopic access for pelvic exenteration in patients with locally advanced rectal cancer (a meta-analysis and a systematic review)
AIM: pelvic exenteration is a surgical procedure for locally advanced pelvic organ cancer in order to achieve optimal resection margins. The expediency of performing such operations with laparoscopic access is controversial. A meta-analysis was done to evaluate the effectiveness of laparoscopic pelvic exenterations for rectal cancer. MATERIALS AND METHODS: a systematic review was conducted in accordance with PRISMA practices and recommendations. Literature search was carried out in the electronic medical literature databases PubMed and eLibrary. According to a meta-analysis of 4 original studies, the results of treatment of 220 patients who underwent laparoscopic exenteration and 311 patients who underwent open surgery were evaluated. RESULTS: significant differences were obtained in the reduction of intraoperative blood loss by 427 ml, 95% CI, p = 0.0004, and postoperative hospital stay by 2 days, 95% CI, p = 0.003 in the laparoscopic group. Comparable data were obtained for the operation time, p = 0.45, for the positive margin of resection (OR 0.85; 95% CI 0.19–3.93; p = 0.84), for the postoperative morbidity (OR 0.62; 95% CI 0.23–1.86; p = 0.34) and for surgical site infections (OR 0.56; 95% CI 0.18–1.64; p = 0.29). CONCLUSION: laparoscopic exenterations are comparable in operation time to open procedure, reduce intraoperative blood loss and postoperative hospital stay days.
Crohn's disease of the appendix. Late outcome of surgery after 37 years (clinical case and review)
OBJECTIVE: based on the analysis of our own clinical observation and literature review, to consider the problem of treatment of Crohn's disease of the appendix. PATIENT AND METHODS: the long-term result (37 years old) of a patient who underwent right-sided hemicolectomy for Crohn's disease of the appendix at the age of 28 is presented. During these years, she did not receive treatment for this disease. In 2024, a comprehensive clinical, instrumental, and molecular genetic study was conducted. RESULTS: According to the results of the examination, no data were found for the recurrence of Crohn's disease, however, a molecular genetic study revealed 2 clinically significant genotypes associated with the risk of Crohn's disease. A review of domestic and foreign literature is presented, including the role of the intestinal mesentery in the pathogenesis of Crohn's disease. CONCLUSION: in the isolated form of Crohn's disease of the appendix, appendectomy is an acceptable surgical treatment option; if the base of the appendix is affected and the cecum dome is involved, colon resection options should be considered. Surgical interventions lead to recovery/long-term remission.
In memory of Nicolay A. Yaitski, аcademician of the RAS
11 июля 2025 года на 87-м году ушел из жизни академик РАН Николай Антонович Яицкий.