AIM: to assess the functional state of the anorectal sphincter apparatus and pudendal nerve conduction in patients with postpartum traumatic anal sphincter insufficiency, as well as to analyze clinical and functional outcomes of surgical correction in the presence of a functional neurogenic component.

PATIENTS AND METHODS: this pilot study included 39 female patients with postpartum anal sphincter insufficiency, with a mean age of 35.0 ± 6.6 years. Preoperative evaluation comprised clinical examination, transrectal ultrasound, anorectal manometry (comprehensive sphincterometry), and stimulation electromyography of the pudendal nerve with assessment of pudendal nerve terminal motor latency (PNTML). Severity of anal incontinence was evaluated using the Wexner score, pain intensity was assessed by the visual analog scale, and evacuation disorders were assessed using the GNCK scoring system. All patients underwent surgical correction using overlapping sphincteroplasty. Postoperative follow-up with repeated clinical and functional assessment was performed in 35 patients.

RESULTS: before surgery, all patients demonstrated decreased resting and squeeze pressures of the anal sphincter according to anorectal manometry. Impaired pudendal nerve conduction was detected in 71.8% of patients, indicating the presence of a functional neurogenic component of anal incontinence. After surgical correction, most patients showed a reduction in the severity of anal incontinence symptoms as assessed by the Wexner score, along with restoration of manometric parameters to physiological ranges. However, signs of pudendal neuropathy persisted predominantly in patients with a mixed mechanism of anal incontinence.

CONCLUSION: the presence of a functional neurogenic component in postpartum traumatic anal sphincter insufficiency influences clinical outcomes of surgical treatment. Comprehensive functional evaluation, including anorectal manometry and pudendal nerve electromyography, is essential for predicting treatment effectiveness and for planning a combined therapeutic approach incorporating both surgical and conservative modalities.

The choice of the extent of surgery in the treatment of transverse colon cancer is a current problem in coloproctology.

AIM: to justify the extent of resection for transverse colon cancer based on the features of lymphatic drainage.

PATIENTS AND METHODS: since October 2023, a prospective observational study has been initiated. As of January 2026, 42 patients with carcinoma of the transverse colon have been enrolled. All patients underwent extended right hemicolectomy with omentectomy and D3 lymph node dissection. To investigate the pathways of lymphatic drainage, intraoperative fluorescent lymphography (IFL) with peritumoral injection of indocyanine green (ICG) was performed. During the pathomorphological examination of the resected specimens, lymph nodes were meticulously dissected from the mesentery in accordance with the Japanese Classification of Regional Lymph Nodes of the Colon. The study involved a correlative analysis of the fluorescent lymphography findings and the results of the morphological examination of the surgical specimen. The evaluated parameters included intraoperative metrics, postoperative complications, and the diagnostic accuracy of fluorescent lymphography.

RESULTS: postoperative complications occurred in 19(45.2%) patients, with Grade I and II complications (according to the Clavien-Dindo classification) accounting for 16(38.1%) cases. The incidence of severe complications (Grade III-IV) was 3 cases (7.1%). Successful IFL was performed in 34(80.9%) patients. Multi-directional lymphatic drainage was observed in 14 cases (41.2%): in two directions in 13 patients (38.2%) and in three directions in 1(2.9%) case. In addition to lymph nodes along the middle colic artery, drainage was visualized towards lymph nodes in the mesentery of the right colon in 9(26.5%) patients and towards the greater omentum in another 9(26.5%) patients. Lymph node metastasis was detected in 14 patients (33.3%), including one case (2.4%) of metastasis in a 202 station lymph node (according to the Japanese classification).ICG-based fluorescent lymphography demonstrated high specificity of 0.95 (95% CI: 0.93–0.97) in identifying lymph nodes without metastases. However, the sensitivity of the method for detecting metastatic nodes was low at 0.15 (95% CI: 0.08–0.25). The positive predictive value (PPV) was 0.38 (95% CI: 0.24–0.54), while the negative predictive value (NPV) was high at 0.86 (95% CI: 0.83–0.89) regarding the absence of metastases in non-fluorescent lymph nodes.

CONCLUSION: the obtained data demonstrate significant variability in lymphatic drainage in transverse colon cancer, including pathways to the mesentery of the right colon and the greater omentum. Extended right hemicolectomy with omentectomy appears to be a justified extent of surgery, ensuring the removal of potential metastatic basins, and shows an acceptable safety profile. ICG-based fluorescent lymphography enables the intraoperative mapping of lymphatic drainage pathways. Further research is necessary to determine whether this technique can serve as a tool for personalizing the extent of surgical resection.

AIM: to evaluate the effectiveness of an organizational and managerial model for CRC screening based on the integration of questionnaire for primary risk stratification and relevant systemic solutions.

PATIENTS AND METHODS: the pilot CRC screening project involved 960 patients — employees of industrial and educational institutions. The organizational and managerial model algorithm included: coordination and monitoring, work with project participants, controlled quality at all stages, identification of “anchor” medical organizations, and interdisciplinary interaction via telemedicine technologies. Participant stratification for subsequent colonoscopy was performed using an original questionnaire developed by the staff of the National Medical Research Center for Coloproctology. For comparative analysis, a quantitative faecal immunochemical test (FIT) was also used in all cases.

RESULTS: after educational lectures, 872 (90.8%) respondents expressed willingness to further participation in the screening program. Of the 280 individuals invited to the second stage, 164 participants (58.6%) consented to participate. All second-stage participants (n = 164) underwent colonoscopy. Indications for deep checkup were present in 127 out of 164 individuals (77.4%). Indications were high risk according to the questionnaire (n = 100), positive FIT result (n = 34). In 7 patients, a combination of positive results was detected for both stratification methods. The remaining 37 out of 164 participants (22.6%) had no formal indications for colonoscopy (negative FIT and low risk according to the questionnaire) and underwent the examination at their own request. According to colonoscopy findings, neoplasms were detected in 95 out of 164 cases (57.9%) (malignant in 2.4%, benign in 55.5%). For the questionnaire method, sensitivity was 73.7% (95% CI: 63.6–82.2), and specificity was 56.5% (95% CI: 44.0–68.4). For the faecal immunochemical test (FIT), sensitivity was 24.2% (95% CI: 16.0–34.1), and specificity was 84.1% (95% CI: 73.3–91.8). As an independent stratification method, the questionnaire identified 3 out of 4 cases of malignant neoplasms (75.0%), whereas FIT identified 2 out of 4 cases (50.0%). The most significant advantage of the questionnaire was demonstrated in the context of secondary prevention of colorectal cancer. Using the questionnaire, polyps were diagnosed in 67 out of 91 patients (73.6%), while FIT detected polyps in only 21 out of 91 patients (23.1%), p < 0.001. In 5 patients (5.5%), positive results were found for both methods. Additionally, in 8 patients with benign neoplasms who underwent colonoscopy at their request, stratification results were negative (low risk according to the questionnaire and negative FIT).

CONCLUSION: the implementation of a combination of widely available primary risk stratification tools (questionnaire) and high-tech solutions (artificial intelligence for endoscopic data analysis) will optimize the approach to screening programs for large populations and enhance their effectiveness.

AIM: to compare the outcomes of open haemorrhoidectomy and stapled hemorrhoidopexy in patients with Grade III and Grade IV haemorrhoids.

PATIENTS AND METHODS: this prospective observational comparative study was conducted at Kasturba medical college, Manipal, from March 2023 to March 2025. 26 patients undergoing open haemorrhoidectomy and 26 patients undergoing stapled hemorrhoidopexy were compared. Parameters assessed included operative time, postoperative pain (VAS on POD 1 and 3), analgesic requirement, bowel activity, urinary retention, postoperative bleeding, duration of hospital stay, return to work, and follow-up outcomes.

RESULTS: grade III haemorrhoids accounted for 88.5% of cases. Operative time was similar in both groups (median: 60 minutes). Postoperative pain scores and analgesic needs showed no significant difference. Urinary retention was significantly higher in the stapled group (34.6%) compared to the open group (11.5%). Other parameters, including return to work and complication rates, were comparable.

CONCLUSION: both open haemorrhoidectomy and stapled hemorrhoidopexy are effective in treating advanced haemorrhoids. However, stapled hemorrhoidopexy demonstrated a higher incidence of urinary retention. Surgical approach can be individualized based on patient profile and resource availability.

AIM: to evaluate discrepancies between subjective intraoperative perfusion assessment and qualitative and quantitative ICG fluorescence angiography, as well as the impact of quantitative perfusion assessment on intraoperative surgical decision-making during colorectal resections.

PATIENTS AND METHODS: this prospective single-center study included patients aged 18 years and older with histologically confirmed adenocarcinoma of the distal sigmoid colon, rectosigmoid junction, or rectum, who underwent surgery with primary colorectal anastomosis between May and November 2025. No restrictions regarding tumor stage were applied. Intraoperatively, fluorescence angiography with ICG (0.1 mg/kg) was performed. Perfusion was assessed using the UFF-630/675-01-BIOSPEC system with quantitative analysis of fluorescence parameters, including maximum intensity (Imax), time to peak intensity (Tmax), inflow rate, and outflow rate. The primary outcome was the frequency of discrepancies between visual, qualitative, and quantitative perfusion assessment of the colonic wall. Postoperative complications were recorded within 30 days and classified according to the Clavien-Dindo classification, while anastomotic leakage was graded according to the ISREC classification.

RESULTS: a total of 20 patients were included in the study. Impaired colonic wall perfusion was identified in 3/20 (15%) patients based on visual assessment, in 3/20 (15%) patients based on qualitative ICG assessment, whereas quantitative analysis revealed signs of reduced perfusion in 6/20 (30%) patients. Subjective perfusion assessment was based on visual signs of blood supply. The presence of bright red bleeding and a visibly pulsatile blood jet were evaluated. The presence of bright red blood alone was considered a doubtful finding, whereas a pulsatile jet of bright red blood was interpreted as a positive result. In the absence of these signs, additional bowel resection was performed prior to ICG assessment. Thus, a discrepancy between subjective visual and quantitative perfusion assessment was observed in 3/20 (15%) patients, and a similar discrepancy between qualitative ICG assessment and quantitative analysis was also observed in 3/20 (15%) patients. Anastomotic leakage occurred in 2/20 (10%) patients, including 1/20 (5%) case of grade A and 1/20 (5%) case of grade B according to the ISREC classification. In both patients, a decrease in Imax to 83% and 87%, respectively, was observed. In one of these patients, visual perfusion assessment was considered adequate, whereas qualitative ICG assessment was classified as weakly positive in both cases. Negative visual and qualitative perfusion assessments were consistent with quantitative findings in 2/20 (10%) patients.

CONCLUSION: the preliminary data demonstrate the presence of discrepancies between subjective, qualitative, and quantitative assessment of intestinal wall perfusion. The clinical significance of these findings should be further evaluated in larger prospective studies.

AIM: to assess and compare the efficacy and safety of underwater endoscopic submucosal dissection (UESD) for superficial epithelial lesions of colon and cecum.

PATIENTS AND METHODS: twenty-six patients with 27 superficial epithelial lesions of the colon and cecum, indicated for monoblock removal, and removed by UESD at a single center were prospectively included in the study (2024– 2025). The primary end point was technical success, defined as macroscopic complete resection.

RESULTS: the resected tumor size was 32 ± 11.6 mm, operative time — 78.0 [49.0; 108.5] min, en bloc resection rate was 100% (27 lesions). R0 resection rate was 96.3% (26 lesions). There were no cases of delayed bleeding and perforation. One patient had postpolypectomy syndrome.

CONCLUSION: UESD is effective and safe strategy for colorectal lesions resection. These results require confirmation in further multicenter randomized trials.

AIM: to assess early and long-term outcomes of interspincteric (ISR) and ultralow anterior resection (ULAR) for low rectal cancer, with a special focus on risk factors for a permanent stoma.

PATIENTS AND METHODS: seventy patients who underwent ISR/ULAR for rectal cancer from January 2019 to December 2023 were included in retrospective study. Patients who underwent ULAR during the same time period was selected after matching by the following parameters: gender, age, body mass index, comorbidities, type of surgical approach, pTNM, tumor stage, degree of differentiation, distance of the tumor from the anus, type of neoadjuvant radiation therapy (n = 58). The overall median follow-up of patients in both groups was 38 (95% CI: 31–41) months. Surgical complications, stoma formation rate, three-year overall (OS) and three-year recurrence-free survival (RFS) were assessed. Multivariate logistic regression analysis was used to identify predictors of permanent stoma. RESULTS: anastomotic leakage was higher after ULAR: 17/58 (29.3%) vs. 10/70 (14.3%) (p = 0.038). Late complications, predominantly functional disorders, occurred more often after AAR: 35/67 (52.2%) vs. 14/55 (25.5%) (p = 0.003). Despite higher odds of stoma reversal after ULAR (odds ratio (OR) 6.5; 95% confidence interval (CI) 1.7–23.9), by the end of follow-up, a greater proportion of patients in this group were living with a permanent stoma: 27/56 (48.2%) vs. 15/67 (22.4%) (p = 0.003). Independent predictors of a permanent stoma were the performance of ULAR (adjusted odds ratio (AOR) 3.54; 95 CI: 1.373–9.13), anastomotic leakage (AOR 11.76; 95 CI: 3.46–40), pN + stage (AOR 1.73; 95 CI: 1.06–2.82) and radiotherapy (AOR 3.92; 95 CI: 1.17–13.09). The prognostic model showed high discriminative ability (Area Under the Curve (AUC) = 0.851; 95% CI: 0.772–0.929). Three-year OS (63.9% (95% CI: 49.9–74.9) vs. 75.0%, (95% CI: 59.7–85.2), p = 0.503) and RFS (48.2% (95% CI: 33.9–61.2) vs. 50.3% (95% CI: 31.2–66.7), p = 0.646) after AAR and ULAR, respectively, were statistically comparable.

CONCLUSION: despite comparable oncological efficacy, ULAR is associated with a higher risk of anastomotic leakage, which is a key factor leading to a permanent stoma. AAR is associated with a higher rate of functional disorders. The choice of surgical technique should be based on an individual assessment of the risk of anastomotic leakage.

Challenges in determining the optimal extent of surgical treatment for patients with rectal cancer with submucosal invasion is still an actual problem in oncoproctology.

AIM: to evaluate the oncological efficacy of “salvage” secondary total mesorectal excision (sTME) in patients with T1 rectal cancer combined with risk factors for metastasis to regional lymph nodes.

PATIENTS AND METHODS: the study included 126 patients with T1 rectal cancer combined with risk factors for regional metastasis, who were treated at the A.N. Ryzhikh National Medical Research Center of Coloproctology from January 1, 2015, to December 31, 2025. Primary total mesorectal excision (pTME) was performed in 40/126 (31.7%) patients due to suspected involvement of regional lymph nodes or depth of invasion of T2 or greater. Transanal endoscopic microsurgery (TEM) for local tumor excision was performed in 86/126 (68.3%) patients. After identification of risk factors for metastasis upon comprehensive pathological examination, all patients were offered salvage surgery — secondary total mesorectal excision (sTME) — which was performed in 22/86 (25.6%) patients, while 64/86 (74.4%) refused radical surgery.

RESULTS: there were no mortalities in any group. The rate of postoperative complications did not differ significantly between the sTME group 6/22 (27.3%) and the pTME group 10/40 (25%) (p = 1). However, complications after TEM occurred 6 times less frequently 4/86 (4.7%) compared to resections (pTME + sTME) 16/62 (25.8%) (p = 0.0003). Patients in the sTME and pTME groups demonstrated a high rate of locoregional metastasis: 22.7% (5/22) after sTME and 32.5% (13/40) after pTME, respectively. The quality of the surgical specimen after sTME was significantly worse than after pTME: 13/22 (59.1%) vs. 10/40 (25%), p = 0.01. The two-year disease-free survival (DFS) was 86.2% (95% CI: 77.2–100) in the pTME group, 100% (95% CI: 100–100) in the sTME group, and 71.6% (95% CI: 67.7–92.6) in the TEM group. Applying the Bonferroni correction, where differences were considered significant at p < 0.017, a certain trend toward worse outcomes was observed in the TEM group compared to the sTME group (p = 0.03). The probability of recurrence in the TEM group without subsequent resection increased by 4.1 times (HR = 4.1; 95% CI: 1.1–15.2; p = 0.03). A similar trend was found in the rate of locoregional recurrences between the sTME and TEM groups (p = 0.05). The probability of local recurrence was 4.8% (95% CI: 0–13.4) in the pTME group, 0% (95% CI: 0–0) in the sTME group, and 23.9% (95% CI: 4.0–25.0) in the TEM group. Thus, the probability of local recurrence in the TEM group was 4.1 times higher (HR = 4.1; 95% CI: 1.0–17.3; p = 0.05) compared to the sTME group.

CONCLUSION: the treatment strategy for patients with rectal cancer invading the submucosal layer and presenting negative prognostic factors represents a complex challenge. The necessity of sTME is dictated by the lack of difference in postoperative complication rates compared to pTME, as well as the high frequency of metastases to locoregional lymph nodes. Refusal of sTME after identifying high-risk factors for metastatic involvement of regional lymph nodes is associated with a significant decrease in disease-free survival rates.

OBJECTIVE: to evaluate the efficacy of PRP therapy following excision of chronic anal fissure (CAF) combined with pharmacological relaxation of the internal anal sphincter using 40 units of botulinum toxin type A (BTA).

PATIENTS AND METHODS: single-center prospective randomized controlled trial (NCT07268261) was held between September 2023 and November 2025comparing outcomes of fissure excision (FE) combined with 40 units of BTA plus platelet-rich plasma injection (FE + BTA + PRP — study group) versus FE with BTA alone (FE + BTA — control group).142 patients were randomized during this period: 70 in FE + BTA + PRP group and 72 in FE + BTA group. 125 patients were included in the final analysis after applying exclusion criteria: 60 in the study group and 65 in the control group. During preoperative and postoperative period patients underwent control examinations, pain intensity assessment using the visual analog scale (VAS), profilometry, and evaluation of transient fecal incontinence using the Wexner scale. The primary end point was the rate of wound epithelialization at 60 days post-surgery.

RESULTS: on the 60^th days, wound healing rates were comparable between both groups: 43/60 (71.7%; 95% confidence interval [CI]: 58.6–82.5) in the FE + BTA + PRP group versus 47/65 (72.3%; 95% CI: 59.8–82.7) in the FE + BTA group (p = 0.936). However, on the 15th days, no patients had epithelialized wounds; on the 30th days, wound healing occurred in 11/60 (18.3%) patients in the FE + BTA + PRP group versus none in the FE + BTA group (p = 0.0003); on the 45th days — in 18/60 (30.0%) versus 3/65 (4.6%) patients respectively (p = 0.0001). No postoperative complications developed in any patient. Transient fecal incontinence on the 30th days was observed in 12/60 (20.0%) patients in the studied group and 10/65 (15.4%) in the control group (p = 0.498); on the 60th days — in 5/60 (8.3%) and 2/64 (3.1%) patients, respectively (p = 0.262). Pain intensity during the day and during defecation in the postoperative period was comparable between two groups throughout the observation period, except of day 10 (during defecation, p = 0.049) and day 12 (during the day, p = 0.036; during defecation, p = 0.035), with lower scores in the control group; by day 60, pain was successfully relieved in almost all patients in both groups. According to profilometry data on the 30th days internal anal sphincter (IAS) spasm persisted in 15/48 (31.3%) patients in the study group and 10/51 (19.6%) in the control group (p = 0.183); on the 60th days — in 15/45 (33.3%) and 11/49 (22.4%) patients, respectively (p = 0.239). No statistically significant differences were achieved in favor of the study group regarding the number of days of temporary disability — 15 (11; 22) days in the FE + BTA + PRP group versus 20 (13; 27) in the FE + BTA group (p = 0.079). Female gender was identified as a factor significantly increasing the odds of absence of epithelialization on the 30th days in univariate logistic regression analysis (odds ratio [OR] = 3.95; 95% CI: 1.09–14.37; p = 0.037). On the 45th days, in addition to gender (OR = 3.29; 95% CI: 1.26–8.61; p = 0.015), significant factors were: treatment method in favor of the FE + BTA + PRP group (OR = 0.11; 95% CI: 0.03–0.41; p = 0.0009); age (OR = 1.07; 95% CI: 1.01–1.13; p = 0.015); and presence of constipation (OR = 5.14; 95% CI: 1.43–18.53; p = 0.013). On the 60th days, only female gender was statistically significantly associated with non-healing wound (OR = 3.22; 95% CI: 1.22–6.66; p = 0.019). No factors influencing the presence of transient fecal incontinence were identified.

CONCLUSION: the use of platelet-rich plasma combined with BTA injection and FE in the treatment of CAF does not increase the rate of postoperative wound epithelialization at 2 months after surgery; however, it offers an advantage by increasing the rate of epithelialization at 30 and 45 days. At the same time this method does not affect the incidence of postoperative complications, pain intensity, functional treatment outcomes, or social and occupational rehabilitation of patients.

INTRODUCTION: familial adenomatous polyposis (FAP) is an hereditary syndrome with an autosomal-dominant type of inheritance, in which patients of young age have dozens, hundreds, and sometimes thousands of adenomatous polyps in the colorectum. If left untreated, it leads to the development of colorectal cancer (CRC) by the third or fourth decade of life. The data presented in the world literature on the characteristics of CRC in the context of FAP, the course of the disease, and the prognosis are scarce and contradictory.

AIM: to study the long-term results of treatment of patients with CRC in the context of FAP, as well as to reveal the factors affecting survival.

PATIENTS AND METHODS: the study included 280 patients who underwent surgery for adenomatous polyposis syndrome between January 2016 and July 2024. The indication for surgery was the presence of more than 100 polyps in the colorectum and/or histologically confirmed colorectal cancer in the presence of multiple (more than 20) polyps in the colorectum. The study included only those patients who underwent radical/conditionally radical surgery with complete cytoreduction. All patients underwent molecular genetic testing (MGT) for the presence of a pathogenic variant in the APC gene, and if none was found, the study was continued with whole-exome sequencing.

RESULTS: according to the results of the MGT, 224 patients were found to have a pathogenic variant in the APC gene, and were diagnosed with familial adenomatous polyposis. Ninety-two (44 females, 48 males) of the 224 patients (41.1%) were diagnosed with colorectal cancer after the pathological examination of the removed specimens. The median age of patients with CRC at the time of surgery was 38 (19–74) years. In 30 (32.6%) of the 92 patients with CRC, the malignant disease was not diagnosed during the preoperative colonoscopy. According to the results of the pathological examination, 40 (43.5%) patients had stage I of cancer, 8 (8.7%) had stage II, 30 (32.6%) had stage III, and 14 (15.2%) had stage IV. The median follow-up period was 27.8 (5–101) months. In 14 (15.2%) patients, the disease progression was diagnosed between 5 and 36 months after surgical treatment. The median disease-free survival was 24.5 months. The actuarial 5-year survival for patients with stage I-II cancer was 100%, stage III — 82.5%, stage IV — 80%. As a result of univariant and multifactorial analyses, the following factors of a negative prognosis proved their independent importance: tumor invasion T4 (HR 14,1; 95% CI 4.62–43.2; p < 0,001), regional lymph nodes status N1a (HR 4.21; 95% CI 1.39–12.8, p = 0.011) and N2b (HR 4,85, 95% CI 1.94–18.61, p = 0.007), peritoneal dissemination M1c (HR 43.8; 95% CI 11.4–168, p < 0.001), the number of malignant tumors in the colon > 1 (HR 1.47; 95% CI 1.00–2.16, p = 0.048).

CONCLUSION: the high frequency of occult polyp malignancy in FAP patients necessitates adherence to oncological principles even during prophylactic surgery in a patient with FAP. The obtained data on the clinical features and course of CRC in patients with FAP correlate with those in patients with sporadic colorectal cancer in the same age group, which may indicate the need to apply the generally accepted approaches to the treatment of oncological patients in patients with colorectal cancer in the context of familial adenomatous polyposis.

AIM: to evaluate the efficacy and safety of a stepwise transition from stimulant laxatives to macrogol-4000 in colorectal patients with chronic constipation, including preoperative bowel preparation for colonic surgery.

PATIENTS AND METHODS: a single-center prospective cohort pilot study with a “before–after” design was conducted. Ninety-three patients (82 women, 11 men; mean age 65.0 ± 14.2 years) were enrolled between January and December 2025, all with chronic constipation and long-term self-administration of stimulant laxatives (median duration 5.0 years; interquartile range 1.0–15.0; range 0.5–35.0 years). Functional constipation was the leading diagnosis 78/93 (83.9%), whereas constipation-predominant irritable bowel syndrome and dolichocolon accounted for 6/93 (6.5%) and 9/93 (9.7%) cases, respectively. The transition protocol comprised a 4-phase tapering scheme of stimulant laxative dose reduction combined with standard-dose macrogol-4000 over 3–8 weeks. Primary endpoints: complete discontinuation of stimulant laxatives at transition completion; change in stool consistency (Bristol Stool Scale, BSS) and stool frequency from baseline to transition completion (3–8 weeks); incidence of therapy-related adverse events. Exploratory endpoint: bowel preparation quality assessed by Boston Bowel Preparation Scale (BBPS) in patients with colonic polyps.

RESULTS: according to the intention-to-treat analysis (all 93 patients), complete discontinuation of stimulant laxatives at transition completion was achieved in 76/93 (81.7%; 95% CI [72.5; 88.9]). Among compliant patients (76/93; 81.7%) who completed the protocol as prescribed (≥ 80% adherence), discontinuation was achieved in 76/76 (100.0%; 95% CI [95.2; 100.0]). Median BSS score significantly improved from 1.0 (interquartile range 1.0–2.0) to 3.0 (2.0–4.0) (p < 0.0001 by Wilcoxon signed-rank test). The proportion of patients with normal stool (BSS 3–4) increased from 4/73 (5.5%) to 51/73 (69.9%) (relative risk 12.7; 95% CI [4.8; 33.6]; p < 0.0001 by McNemar's test). Mean stool frequency increased from 0.68 ± 0.21 to 1.11 ± 0.33 bowel movements per day (p < 0.0001). Therapy-related adverse events occurred in 4/93 (4.3%) patients (mild bloating, not requiring therapy discontinuation). Normalization of colonic transit (complete laxative independence) was achieved in 16/76 (21.1%) of patients. Mean transition duration was 5.2 ± 1.2 weeks. No diarrhea (BSS ≥ 6) was observed upon therapy completion. In 15/15 (100%) patients with colonic polyps, transition to macrogol-4000 provided adequate bowel preparation for colonoscopy and subsequent polypectomy without stimulant laxatives (median BBPS score 8.0 [7.0; 9.0], range 6–9).

CONCLUSION: the stepwise protocol for replacing stimulant laxatives with macrogol-4000 demonstrates high efficacy and safety in colorectal patients. Macrogol-4000 provides reliable constipation correction and adequate preparation for diagnostic and surgical interventions on the colon. These results justify a randomized controlled trial to verify the findings

AIM: to evaluate the impact of comorbid cardiovascular disease on surgical outcomes in patients with colorectal cancer.

PATIENTS AND METHODS: a single-center retrospective study of the early outcomes included 457 patients who underwent elective surgery with resection of the primary tumor for stage 0–4 colorectal cancer from January 2022 to December 2024. The main group included 285 patients with colorectal cancer and verified diagnosis of cardiovascular disease, necessarily including coronary artery disease. The control group consisted of 172 patients with colorectal cancer and without coronary artery disease. The primary endpoints of the study were: the incidence of postoperative complications and postoperative mortality, determined within 30 days after surgery for colorectal cancer. Secondary endpoints were: the surgery volume and access, the anastomotic leakage and colostomy rate.

RESULTS: the Charlson Comorbidity Index (6 [5;8] versus 4 [3;5]) and the ASA in patients in the main group were higher compared to the control group, respectively (p < 0.001). The volumes of surgery for all tumors were comparable. In the main group, laparotomy was used more often — 42/285 (14.7%), in the control group — 12/172 (7.0%), p = 0.013. In the main group, they more often refused for primary anastomosis (Hartmann's procedure in 30/285 patients (10.5%) vs 4/172 (2.3%) in the control group, p < 0.001). The postoperative morbidity was higher in the main group — 91/285 (31.9%), in the control group — 30/172 (17.4%) (odds ratio (OR) 2.22; 95% confidence interval (CI): 1.39–3.54; р < 0.001) due to an increased risk of cardiovascular complications. Complications of grade IV (A + B) severity according to Clavien-Dindo in the main group was detected in 13/285 (4.6%) of all patients, in the control group — 1/172 0.6% (OR 8.17; 95% CI: 1.06–63.04; р = 0.022). Postoperative mortality in the main group was 2/285 (0.7%), in the control group — 0/172 (0%), without a reliable difference in statistically significant differences in values (OR 3.04; 95% CI: 0.15–62.5; р = 0.530).

CONCLUSION: comorbid cardiovascular disease and coronary artery disease significantly impact the outcomes of surgery for colorectal cancer. These patients should be managed in multidisciplinary hospitals. Percutaneous coronary interventions should be performed first.

AIM: to evaluate the functional state of the anal sphincter and pudendal nerve conduction in patients with postpartum traumatic anal sphincter incontinence (AI), and to analyze the correlation between the clinical severity of AI according the Wexner scale.

PATIENTS AND METHODS: the prospective cohort study included three centers. The study enrolled patients with postpartum AI scheduled for surgical sphincter repair as the primary treatment stage (June 1, 2025, to October 31, 2025). Endpoints were the clinical severity of AI (Wexner scale) pre- and post-surgery, the functional state of the anal sphincter complex via anorectal manometry, and the terminal motor latency (M-response) of the external anal sphincter during pudendal nerve stimulation (PNTML) prior to surgery. Changes in Wexner scores were analyzed relative to PNTML values, alongside the overall correlation between functional diagnostic parameters and perioperative AI severity.

RESULTS: thirty-nine patients were analyzed. Preoperatively, the median Wexner score was 11.0 (Q1-Q3 9.0–15.0). Comprehensive sphincterometry revealed a median resting pressure (MRP) of 33.0 (29.0–36.0) mmHg and a median maximum squeeze pressure (MSP) of 74.0 (63.0–87.0) mmHg. Stimulation electromyoneurography (ENMG) showed preserved motor fiber conduction (PNTML) in 11 patients (28.2%): median values were 2.1 (1.8–2.3) ms on the right and 2.3 (1.8–2.4) ms on the left. Normal latency was detected in 11 patients (28.2%), unilateral latency prolongation in 14 (35.9%), and bilateral prolongation in 14 (35.9%) patients (median: right 3.1 [2.7–3.8] ms; left 2.9 [2.6–3.4] ms). Postoperatively, the median Wexner score for all patients improved to 2.0 (1.0–4.0). Significant improvements in continence were detected across all subgroups: in patients with normal M-responses, the median score decreased from 10.0 (8.0–15.0) to 1.0 (0.0–1.0) (p = 0.0038); in those with unilateral prolongation, from 12.0 (10.0–16.0) to 2.0 (2.0–5.0) (p = 0.0011); and in those with bilateral prolongation, from 11.0 (9.0–14.0) to 2.5 (2.0–5.0) (p = 0.0058).

CONCLUSION: functional studies of the anal sphincter complex in patients with post-traumatic AI are essential for predicting the outcomes of sphincteroplasty and ensuring a comprehensive, individualized approach to treatment selection. The presence of a neurogenic component in the pathogenesis of AI does not preclude the high efficacy of surgical correction; however, it plays a significant role in determining a combined treatment strategy. Furthermore, the effectiveness and clinical necessity of neurostimulation as an adjunctive therapy following sphincterolevatoroplasty warrant further investigation.

AIM: to justify the extent of resection for transverse colon cancer based on the lymphatic drainage.

PATIENTS AND METHODS: since October 2023, a prospective observational study has been initiated. As of January 2026, 42 patients with carcinoma of the transverse colon have been included. All patients underwent extended right hemicolectomy with omentectomy and D3 lymph node dissection. To evaluate the pathways of lymphatic drainage, intraoperative fluorescent lymphography (IFL) with peritumoral injection of indocyanine green (ICG) was performed. Lymph nodes of removed specimens were meticulously dissected from the mesentery in accordance with the Japanese Classification of Regional Lymph Nodes of the Colon. The study involved a correlative analysis of the fluorescent lymphography findings and the results of the morphological examination of the surgical specimen. The evaluated parameters included intraoperative metrics, postoperative complications, and the diagnostic accuracy of fluorescent lymphography.

RESULTS: postoperative complications occurred in 19 (45.2%) patients, with Grade I and II complications (according to the Clavien-Dindo classification) accounting for 16 (38.1%) cases. The rate of severe complications (Grade III-IV) was 7,1% (3/19). Successful IFL was performed in 34 (80.9%) patients. Multi-directional lymphatic drainage developed in 14 cases (41.2%): in two directions in 13 patients (38.2%) and in three directions in 1 (2.9%) case. In addition to lymph nodes along the middle colic artery, drainage was visualized towards lymph nodes in the mesentery of the right colon in 9 (26.5%) patients and towards the greater omentum in another 9 (26.5%) patients. Lymph node metastasis was detected in 14 patients (33.3%), including one case (2.4%) of metastasis in a 202 station lymph node (according to the Japanese classification).ICG-based fluorescent lymphography demonstrated high specificity of 0.95 (95% CI: 0.93–0.97) in identifying lymph nodes without metastases. However, the sensitivity of the method for detecting metastatic nodes was low at 0.15 (95% CI: 0.08–0.25). The positive predictive value (PPV) was 0.38 (95% CI: 0.24–0.54), while the negative predictive value (NPV) was high at 0.86 (95% CI: 0.83–0.89) regarding the absence of metastases in non-fluorescent lymph nodes.

CONCLUSION: the data obtained demonstrate significant variability in lymphatic drainage in transverse colon cancer, including pathways to the mesentery of the right colon and the greater omentum. Extended right hemicolectomy with omentectomy appears to be a justified extent of surgery, ensuring the removal of potential metastatic basins, and shows an acceptable safety profile. ICG-based fluorescent lymphography enables the intraoperative mapping of lymphatic drainage pathways. Further research is necessary to determine whether this technique can serve as a tool for personalizing the extent of resection.

This clinical case presents a successful treatment experience in a young patient with a large desmoid tumor and familial adenomatous polyposis syndrome, previously operated on for rectal cancer with proctocolectomy.

OBJECTIVE: to analyze the epidemiology and pathophysiology of the disease and evaluate the tactics of working with this pathology, we reviewed the global medical literature, the patient's anamnestic data, the results of diagnostics and intraoperative decisions, and the results of histological examination of the surgical specimen.

PATIENTS AND METHODS: patient K., 28, presented as part of the dynamic monitoring of her primary oncological disease in February 2022. Rectal cancer at 5 cm cT2N0M0 (urTisN0M0), ARS syndrome, histologically — intestinaltype adenocarcinoma and abdominal discomfort not relieved by analgesics. In April 2022, she underwent chemoradiation therapy with preliminary ovarian transposition, followed by a proctocolectomy with the creation of a pelvic small bowel pouch. In March 2024, she became pregnant naturally, delivering a healthy baby via cesarean section. In April 2025, during oncology monitoring, a 6 cm diameter pelvic mass was detected, which, according to CT and MRI, reached 13.5 cm in diameter four months later. An ultrasound-guided puncture was performed for histological confirmation, and the diagnosis was desmoid fibromatosis. A consultation was held, and the decision was made to remove the desmoid tumor and perform an obstructive resection of the pouch.

RESULTS: an analysis of the literature on the practical aspects of treating this pathology was conducted, highlighting the need to develop standardized clinical guidelines for the prevention, diagnosis, and treatment of intra-abdominal desmoids due to the unpredictable course of this disease and the lack of clearly established patient management concepts.

CONCLUSION: this clinical case is notable for its rare occurrence of a desmoid tumor, poorly studied in the medical community, which arose in a young patient diagnosed with familial adenomatous polyposis and the fact of a spontaneous pregnancy following pelvic radiation therapy and extensive surgical intervention.

Demonstration of the possibility of successful removal of a subepithelial neoplasm of the rectum by endoscopic submucosal-intermuscular dissection (EPMD). In a 50-year-old patient, a colonoscopy in the department of endoscopic diagnostics and surgery in the middle ampullary rectum revealed a subepithelial neoplasm up to 0.5 cm in diameter, yellowish in color, and the mucous membrane above the neoplasm was unchanged. On instrumental palpation, the formation was difficult to shift, of a dense consistency, and the symptoms of a “tent” and “pillow” were negative. EPMD was performed.

The postoperative period was uneventful, and the patient was discharged on the 5th day after surgery.

Morphological conclusion: leiomyoma of the intrinsic muscle plate of the mucosa. Resected at the level of the inner muscle layer, the edges of the resection are intact.

AIM: to present and discuss the challenges of radiological and endoscopic diagnosis of cancer within a colonic diverticulum in patients with diverticulitis, using a clinical case as an example.

PATIENTS AND METHODS: a 76-year-old female patient underwent clinical and instrumental examination for exacerbation of sigmoid diverticular disease.

RESULTS: based on the findings of radiological and endoscopic examinations, a chronic pericolonic inflammatory infiltrate of the sigmoid colon involving the uterine stump was identified, showing signs of neoplastic growth within a diverticulum, as well as a tumor in the ascending colon. The patient underwent simultaneous right hemicolectomy and combined anterior resection of the rectum with extirpation of the uterine stump. Pathomorphological examination revealed a poorly differentiated adenocarcinoma with signs of impaired DNA mismatch repair (dMMR) within the diverticulum, and a tumor in the ascending colon with similar characteristics.

CONCLUSION: cancer arising in a colonic diverticulum presents a complex diagnostic challenge due to its unique growth patterns and the need to differentiate it from complicated forms of diverticular disease. In such cases, a thorough and comprehensive clinical and instrumental examination is necessary for adequate planning of surgical treatment.

The review evaluates current approaches to complex cryptoglandular anorectal fistulas and various outcomes following sphincter-preserving procedures, and assesses the efficacy and safety of various treatment methods. The paper primarily focus on existing applications of stem cells technologies in treatment of cryptoglandular fistulas, critical examining the use of autologous adipose tissue as a source of mesenchymal stem cells. Based on current literature, this method is safe, and minimally invasive, moreover it has significant potential, in the treatment of complex rectal fistulas. However, its implementation in clinical practice requires further research and standardization of both preparation processes and application technology.