The article is focused on surgical treatment of slow-transit constipation from point of accordance of treatment goal and surgery goal and consequences of surgery.

OBJECTIVE. Assessment of diagnostic significance of exosomal microRNAs analysis in colorectal cancer (CRC). MATERIALS AND METHODS. Plasma samples from 100 patients with colon tumors and 20 healthy donors. Exosomes were isolated by differential ultracentrif ugation the analysis was performed by dynamic light scattering (DLS), cryo-EM, flow cytometry. Quantitative analysis of exosomal microRNAs was performed by RT-PCR. To evaluate the results obtained, the Kraskel-Wallis statistical test and ROC analysis were used. RESULTS. It is shown that CRC causes characteristic changes in the concentration of a number of exosomal microRNAs. Analysis of «reciprocal miRNAs pairs» was proposed as algorithmfor personalized diagnostic of CRC. The optimal parameters of diagnostic values were obtained for miRNA pair«miR-223 / miR-181a» (sensitivity =0.93, specificity =0.88). CONCLUSION. The analysis of exosomal microRNAs presents a promising method for early diagnostics / screening of colorectal cancer.

AIM. Evaluation of the results of the implementation of ERP in practice. MATERIALS AND METHODS. Two consecutive series of patients were analyzed. The first cohort was recruited in 2013-2015 (n=124), the second - in 2015-2017 (n=152). Patients were randomized into groups with traditional management and ERP. The postoperative complications, length of stay (LOS) and program adherence were estimated. RESULTS. There was no difference in complication rate in first and second series, and between groups. The postoperative length of stay in the first cohort of patients with ERP was 4.7±0.1, in the second - 5.8±0.2 days (p=0.0003). Age and comorbidity rate did not affect the outcomes of treatment. The factor associated with doctor was significant in terms of discharge. The postoperative LOSin patients with traditional management decreased from 9±0,6 to 7,8±0,3 (p=0,046) with implementation of ERP. CONCLUSION. ERP reduces the postoperative length of stay and does not affect the postoperative complications. This Protocol is doctor-dependent. The implementation of ERP improves the results of treatment for all patients in the clinic.

BACKGROUND: Preventive ileostomy closure has potential risk of severe complications with 30% rate of postoperative morbidity and 4% rate of mortality. There is no relevant data (evidence) which method of ileostomy closure is a method of choice. AIM. To identify effective and safe method of ileostomy closure. PATIENTS AND METHODS. A prospective randomized controlled single centre trial was carried out in State Scientific Centre of Coloproctology (Moscow, Russia) during the period 2015-2017. Patients with defunctioning ileostomy were randomized to closure by hand-sewn end-to-end anastomosis group, by hand-sewn side-to-side anastomosis group and by stapled side-to-side anastomosis group. RESULTS. The trial recruited 327 patients. Mortality rate was 0.3%, one post-op death occurred in hand-sewn side-to-side anastomosis group (p=1.0). Morbidity rate was 14.4% in hand-sewn end-to-end anastomosis group, 18.4% in hand-sewn side-to-side anastomosis group and 11.7% stapled side-to-side anastomosis group (p=0.5). Hand-sewn side-to-side anastomosis was associated with longest time of anastomosis creation (49.3 min p<0.05), longest total operative time (105.7 min p<0.05) and longest post-op stay (9.3 days; p<0.05). Stapled anastomosis was faster than hand-sewn (20 min vs 33.1 min and 49.3 min; p<0.001). CONCLUSION. Superiority in ileostomy closure methods was not obtained. Stapled side-to-side method makes procedure significantly faster and significantly reduces postoperative ileus rate.

OBJECTIVES OF RESEARCH. To assess the clinical effectiveness of phlebotrophic drug Detralex (Micronized purifiedflavonoid fraction (MPFF)) during complex treatment of patients with acute hemorrhoids. MATERIALS AND METHODS. A comparative analysis of treatment outcomes of 293 patients with acute hemorrhoids was conducted. All patients were divided into two groups for further clinical observations. Standard drug therapy was performedfor 145 patients (group I). For 148 patients (group II), in addition to the standard treatment, phlebotrophic drug Detralex was additionally initiated. Research program included detection of content of acute inflammatory phase reactants and pro-inflammatory cytokines in blood plasma, evaluation of pain syndrome severity (VRS) and quality of life parameters (SF-36 questionnaire). RESULTS. Initiation of MPFF with complex treatment of patients with acute hemorrhoids was found to be contributed to faster elimination of edema and inflammation, a decrease in severity of hemorrhoids thrombosis, relief of pain syndrome and improvement in patients'quality of life, along withwell-marked regression of laboratory markers of inflammatory reaction This allows to increase the number of good outcomes of acute hemorrhoids treatment from 66,2% to 89,9%, that is by 23,7% and to reduce the number of unsatisfactory outcomes from 4,2% to 1,3%, that is by 2,9%. CONCLUSION. Inclusion of Detralex into program of acute hemorrhoids treatment contributes to a faster elimination of clinical and laboratory manifestations of the disease and allows improving the results of treatment for this category of patients.

AIM. To revise clinical approaches for patients with complicated diverticular disease used in daily clinical practice in tertiary referral regional center and its compliance with Federal Guidelines. PATIENTS AND METHODS. Twenty-three patients with inflammatory complications of diverticular disease were treated in a General Surgery Department of Regional Hospital of Tumen City in 2015-2016. Preoperative ultrasound was performed for 19 (82.6%) patients, CT - only for 4 (17.4%), laparoscopy - for 13 (56.5%). Seven of them had uncomplicated acute diverticulitis and were treated conservatively. Sixteen (69.6°%) patients underwent Hartmann procedure. Five of them had phlegmonous diverticulitis, 10 - sealed perforation and only 1 - free perforation with fecal peritonitis. RESULTS. According to recent studies in diverticular disease, conservative approach had positive prognosis in 15 of 16 operated patients. All procedures included extended resections with an aim to remove not only inflamed segment of bowel but segments with multiple diverticula as well. Distal part of sigmoid colon was included in specimen in all cases. CONCLUSION. None of recommendations of Federal Guidelines was used in daily clinical practice for patients with diverticular disease and indications for surgery were unreasonably extended in majority of cases. A juridical status of Federal Clinical Recommendations should be increased.

5-year results of combined treatment of 160 patients with respectable rectal cancer (TNM: IIab - IIIa-b) are analyzed. In 40 patients (study group)) neoadjuvant (72 h before surgery), endovascular oil Chemoembolization of the Rectal Arteries (RACHEL procedure) with a Lipiodol and 5-Fluorouraci was used. The results were compared with surgical treatment (control group 1, n=40) and preoperative radiotherapy methods (control group 2: 5 х 5 Gr, up to a Total Focal Dose of 25 Grandcontrolgroup3: High Dose radiotherapy with a Single Focal Dose of 13 Gr with program Endovascular Radio modification Metronidazole, for 40 patients). The preoperative RACHEL procedure in treatment of patients with resectable rectal cancer was effective with low local recurrence (2,6%) rate, at 5-year overall (89,7%) and disease -free survival (84,6%) and can compete with known preoperative radiotherapy in combined treatment of rectal cancer.

AIM. To analyze the results of treatment of patients with diverticular disease in Coloproctology Department. MATERIALS AND METHODS. During the periodfrom 2001 to 2017, 223 patients with diverticular colon disease were treated in the hospital. RESULTS. 191 (85,7%) were treated conservatively, 32 (14,3%) patients were operated on. One-stage procedure was performed in 21 (67,7%) patients, in 10 (32,3%) bowel resection has been completed by stoma. Postoperative complications developed in 25% of cases. Postoperative mortality was 3,1%. Operations reconstructive the length of the intestinal tube were performed in 24 previously operated patients. Colostomy reversal was combined with secondary resection in 9 (37,5%) patients CONCLUSION. Diverticular disease of the colon is a widespread condition with a wide spectrum of severe complications requiring surgical correction. In work with this pathology it is necessary to strictly observe uniform standards of diagnostics and treatment.

INTRODUCTION. About 75% of patients with Crohn's disease (CD) required surgery due to the complications of CD. Surgical treatment does not cure this disease. The question of appropriate therapy for the prevention of postoperative reccurence of CD remains open until now. The purpose of this study was to compare immunosuppressive and biological therapy as a postoperative preventive therapy. MATERIALS AND METHODS. 91 patients with CD who underwent surgery in the A.N. Ryzhykh State Scientific Center for Coloproctology of the Ministry of Health of Russian Federation from 2010 to 2017 were included in the study. Patients who had inflammation in the remaining areas of the intestine in the outcome of surgical treatment were excludedfrom the study. After surgery, patients were randomized into 3 groups. In the first group preventive therapy was carried out with azathioprine, in the second group with adalimumab, in the third group, patients received combination therapy with azathioprine and adalimumab. Clinical, endoscopical and laboratory assessment of disease activity was conducted at 3, 6 and 12 month after the surgery. RESULTS. During one year of preventive therapy with azathioprine, adalimumab, or a combination of this medications, relapse occurred in 17 patients (17/83, 20%). There were no statistically significant differences between the groups in any of the stages of evaluation. CONCLUSION: The data obtained in the study allow to conclude that the frequency of relapses of CD on postoperative preventive therapy does not depend on the specific drug, as well as on demographic and anamnestic parameters.

OBJECTIVE. To study the effect of active extracellular substances of lactobacilli and antimicrobial agents on the inhibition and destruction of the biofilms formed clinically relevant microorganism strains. MATERIALS AND METHODS. The study of the impact of different agents on the biofilmformation and growth was carried out on resistant clinical strains of microorganisms obtainedfrom patients with post-surgical infectious inflammatory complications. We used wound dressing solution, cutaneous antiseptic, filtrates of 19 clinical strains of lactobacilli and a strain of Lactobacillus plantarum from the probiotic «Lactobacterin dry» (Microgen Nizhny Novgorod, series 46 / 06-1209) as a reference strain-producer of bacteriocins for biofilm inhibition. Biofilms were incubated for 48 hours on glass carriers at 37°C and visualized with a light microscope at 960x magnifying. RESULTS. All substances possess a good inhibitory potential and have approximately same level of effect. The skin antiseptic and wound washing fluid have only an inhibiting effect on the biofilmformation process, while the having a bactericidal effect on plantonicform of the cells. The lactobacilli filtrate inhibited the biofilmformation and was also able to destroy preformed 24-hour bacterial films. CONCLUSION. The use of lactobacilli bacteriocins can reveal additional opportunities for combating the infection associated with biofilm forming microorganisms.

Early diagnostics, treatment and types of surgery of perforated diverticulitis were studied. Archive data of patients with this complication treated in proctology department of City Clinical Hospital №21 (Ufa city, Russia) between 2000 and 2016 were analyzed.