The incidence of clinically significant anastomotic leakage (AL) after low anterior resection (LAR) of the rectum varies from 3 % to 21 %, and the postoperative mortality associated with AL is 6,0-39,3 %. Preventive stoma (PS) formation is the most common method for the anastomosis protection. AIM to assess the impact of PS on the AL rate and severity. PATIENTS AND METHODS: It was prospective non-randomized cohort study. Results of LAR in 247 patients operated on mid- and low rectal cancer between 2003-2011 were analized. Of 247 patients 202 had PS and 45 had no PS. RESULTS: AL developed in 34/247 (13,7%) cases. Univariate analysis revealed higher AL rate in patients without PS: 22,2 % (10/45) vs. 11,9 % (24/202), p=0,06; r=-0,37, OR 2,1. Multiple logistic regression analysis demonstrated absence of PS as independent risk factor of AL (p=0,03). The probability of AL associated peritonitis in patients without PS is 20 times higher than in patients with PS: 80 % (8/10) vs. 16,7 % (4/24); OR 20; p=0,001; r=-0,67, the probability of lethal outcome is 7,5 times higher: 60% (6/10) vs. 16,7% (4/24); OR 7,5; p=0,01; r=-0,75. CONCLUSIONS: Formation of PS after LAR of the rectum reduces the AL rate, AL associated mortality and severity of complications.

AIM. To improve short and long-term results of reconstructive surgery in patients with complicated colorectal cancer. PATIENTS AND METHODS. Results of 63 patients who had Hartmann procedure for complicated colorectal cancer and thereafter undergone reconstructive surgery were analized. RESULTS. Restorative surgerys was performed at different time interval after the primary surgery. Sphincterometry was done in all patients with the aim to assess the functional integrity of the anal sphincter. CONCLUSION. Suggested optimal period for reconstructive surgery is 1-3 months after the primary surgery.

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

AIM. To evaluate long-term results of treatment of patients with the complicated diverticular diseases, after elective colonic resection. PATIENTS. The outcome of 53 patient operated on pretreated recurrent diverticulitis were compared to results of treatment of 50 patients with diverticulitis complicated by perforation and treated initially by colostomy formation. RESULTS. In the first group the number of patients with postoperative functional gastrointestinal frustration and infringements in psychic and emotional sphere were higher, than in second group and correlated to presence of them before operation. Assessment of quality of life using MOS-SF 36 demonstrated decrease of score in all scales of the questionnaire infirst group, while in second group average score was comparable to healthy individuals. CONCLUSION. Indications for elective colonic resectionfor recurrent diverticulitis should be stricter.

AIM. To improve results of complex treatment of the pilonidal disease (PD). PATIENTSS AND METHODS. 31 patients with the PD were included into study. Of them in 16 patients postoperative wound was left open and vacuum therapy was applied. In 15 patients postoperative wound was left open and managed by ointment dressing. Groups of patients were well matched in terms of age, gender, degree of inflammation and co-morbidity RESULTS. Application ofvacuum therapy reduced the time of wound healing to 27,5±3,6 days comparing to 79±6,6 days of wounds managed routinely. The mean decrease of wounds' area at POD14 treated by vacuum therapy and without was 60 % vs. 20 % correspondingly. Reduction of pain intensity according to a visual analog scale in group with vacuum therapy (1,5/2,2 vs. 1,8/2,8) and earlier return to original occupation (31±3,9 vs. 39±5,7) was noted. Wound infection developed only in 3/15 (20 %) patients managed by ointment dressing. There was no recurrence of the disease regardless wound management. CONCLUSION. Management of postoperative wound by vacuum therapy in patients after surgery for PD improved results of treatment.

The analysis of short-term results of 117 laparoscopic and 16 robotic-assistant colon surgeries, performed in NMSC N.I.Pirogov between January 2011 and May 2015 was undertaken. There were 90 resections for colon cancer, 31 for diverticular disease and one for megacolon. Also results of 11 reconstructive operation after Hartmann procedure was investigated. In 74 cases of cancer operation were performed with mesocolonectomy and central vessels ligature. In 16 patients sceletization of inferior mesenteric artery and paraortal lymphadenectomy was performed. Morbidity rate was 11,3 % among all patients. The use of robotic technology in colon surgery is not an optimal option due to low cost effectiveness and prolonged operating time comparing to those after routine laparoscopic procedures.

AIM to assess results of stapling anastomosis in colorectal surgery. PATIENTS AND METHODS. The results of surgical treatment of 427 patients with rectal cancer and 458 patients with colon cancer (T1-4N0-2M0-1) were analyzed. A circular stapler was used to perform end-to-end (347patients) and side-to-end (80 patients) anastomosis. 164 patients underwent stapling colonic anastomosis. RESULTS. Anastomotic leak rate after stapled colorectal anastomosis was 8,7% (n=37) and was lower after side-to-end anastomosis 3,8% (n=3). Anastomotic leakage developed in only 2 (1,2%) patients after colon anastomosis. CONCLUSION. Proper use of stapling devices and proper surgical technique allow to create reliable anastomosis which safety is comparable the manual one.