AIM: to work out and to implement multistage colorectal cancer treatment as a standard of surgical care in Moscow PATIENTS AND METHODS: Five-hundred seventy-two patients were included in the study reviewed: 247 of them were hospitalized in 2011-2013 (I group); 325 - in 2014-2017 (II group). Forty-six patients underwent conservative treatment; 302 - urgent bowel resection; 141 - proximal stoma formation; 83 - endoscopic stent insertion. One-hundred ten patients of the II group underwent elective bowel resection after 0,5-6 months and further chemoradiotherapy. The 3-year cumulative survival was assessed with Kaplan-Meier method. Multistage treatment was implemented as a standard of surgical care in Moscow for colorectal cancer complicated by obstruction. Postoperative mortality and morbidity rate were estimated in 2014-2018 in Moscow. RESULTS. Complications occurred in 46,69 % (I group) and 21 % (II group) (p<0.05). Postoperative mortality was significantly higher in I group compared with II group: 26,11 % vs 10,33 % p<0.05). The survival rate was higher in II group than in I group (0,82 vs 0,69, p<0.05). The result was a decrease in postoperative mortality in Moscow from 22.4 % to 10.0 %. CONCLUSION: the efficacy of the new standard of medical care of colorectal cancer complicated by bowel obstruction is confirmed. A «bridge» strategy may be a valid alternative in these patients, because of significantly lower postoperative mortality and morbidity rate.

AIM: to decrease anastomotic leakage rate using transanal and transabdominal reinforcing sutures of staple line of colorectal anastomosis. PATIENTS AND METHODS: a prospective randomized trial is started. The main group included patients which underwent anterior or low anterior resection of the rectum with reinforcing of the staple line of colorectal anastomosis using reinforcing sutures on 2, 4, 6, 8, 10 and 12 by conventional dial. The control group consisted of patients without reinforcing of the anastomosis line. RESULTS: from November 2017 to October 2018, 127 patients underwent anterior or low anterior resection of the rectum, 80 of them were included in the study,six were excluded from the study after surgery. Among these 74 patients 40 (54.0 %) were females, mean age was 63.0± 11.0 years. Forty patients consisted the main group, 34 - control. The anastomotic leakage rate in the main group was 7% (3/40), in the control - was 26 % (9/34) (p=0.06). The clinical anastomotic leakage rate in the main group was 3 % (1/40), in the control group - 21 % (7/34) (p=0.03). The anastomotic leakage rate in the main group, after anterior resection of the rectum was 13 % (2/15), in the control - 0 % (0/8) (p=0.8). After low anterior resection the anastomotic leakage rate in the main group was 4 % (1/25), in the control - 35 % (9/26) (p=0.016). Multivariate analysis of risk factors of anastomotic leakage significance associated with male gender (OR 6.88, CI 1,32-of 35.9, p=0,022), positive bubble test (OR 6.26, CI of 1.22-32,2, p=0.028), absence of reinforcing of the anastomosis (OR 4.39, CI 0,96-20,12, p=0,056). CONCLUSION: the reinforcing of colorectal anastomoses decreases anastomotic leakage rate after low anterior resection.

AIM: to evaluate the effectiveness of bowel cleansing before colonoscopy using enteral nutrition agent «Nutridrink» as the single nutrient. MATERIALS AND METHODS: a prospective comparative study included 150 patients (83 females, aged 20-65 years), who underwent diagnostic colonoscopy. To assess the quality of bowel cleansing the Likert scale was used. Subjective assessment of patients' comfort was performed by patients on a 10-point visual scale (from 0 - «excellent» to 10 - «extremely negative»). RESULTS: the quality of colon cleansing before colonoscopy was significantly better in patients who got enteral nutrition, especially in comparison with patients with standard protein diet. Subjective assessment of comfort during cleansing was better in the group of patients who used Nutridrink as the only source of nutrition as well. CONCLUSION: use of enteral nutrition as a part of bowel cleansing before colonoscopy can replace the protein diet.

AIM: to evaluate changes of anorectal manometry parameters and clinical symptoms of fecal incontinence 3 months after fistulectomy with primary sphincteroplasty. MATERIALS AND METHODS: fifty-two patients (37 males) with complex anal fistulae of cryptoglandular origin underwent fistulectomy and primary sphincteroplasty. The fistulas were recurrent in 13 (25 %) cases, 8 (15,4 %) patients had preoperative fecal incontinence. Fecal incontinence Wexner score was 0,46 (0-8) before surgery. Anorectal manometry was performed before and 3 months after surgery. RESULTS: three months days after surgery mean and maximum resting anal pressure were not significantly low compared with the baseline. In patients with initially normal data before the surgery (n=22), resting anal pressure was significantly lower (before surgery M=56,1 ± 7,6 [46,1-69,0], after surgery 45,5 ± 8,8 [38,0-63,0], p=0,006, Wilcoxon test). There were no significant changes in squeezing anal pressure. Resting anal pressure has become below the normal after surgery in 13 (59.1 %) patients. Clinical symptoms of fecal incontinence was detected in 10 patients postoperatively (gas incontinence and soiling). Fecal incontinence Wexner score was 1,64 (0-11) after surgery (p=0,007). CONCLUSION: fistulectomy with primary sphincteroplasty leads to change of resting anal pressure basically in patients with initially normal pressure and mainly - in patients with anterior fistulas. Fecal incontinence symptoms after with surgery produced 26,3 % patients. These data confirm the need of individual approach when choosing the method of surgical treatment of analfistulae.

AIM: to evaluate the efficacy of new «invaginative» method for rectovaginal fistulas. MATERIALS AND METHODS: thirty-seven females aged 37.3 (20-73) years with high rectovaginalfistulas (RVF) were included in the study. All patients underwent fistula surgery using novel «invaginative» method, which includes invagination of the fistula tract into the rectum, RVF origin included inflammatory bowel diseases in 7 (18.9%) patients, delivery injury - in 21 (56.7%), pelvic surgery - in 5 (13.5%), other causes - in 4 (10.8 %). Twenty (54.1 %) patients had two previous unsuccessful repairs on average. Diverting stoma formation as a first stage for RVF repair was performed in 4 (10.8%) patients. Meanfollow-up was 14,7± 6,6 months. RESULTS: «invaginative» method has been performed in all patients. Eight (21.6 %) of them produced recurrence after 2-6 weeks after surgery. No postoperative complications occurred. CONCLUSION: «invaginative» method is a safe and effective in treatment of high rectovaginal fistulas. It can be performed without diverting colostomy in most cases.

AIM: to evaluate efficacy of PICOPREP (sodium picosulfate, magnesium oxide and citric acid) for bowel cleansing before colonoscopy compared to LAVAKOL (polyethylene glycol, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride) and FLEET PHOSPHATE (sodium phosphates mixed). MATERIALS AND METHODS: a randomized single center study included 365 patients. LAVAKOL group included 320 pts, PHOSPHATE-SODA group -165 and PIKOPREP - 150. Evaluation criteria included laboratory data, organoleptic features of the drug, subjective perception of the drug by patients and the quality of bowel cleansing. RESULTS: minimal laboratory changes occurred only in FLEET PHOSPHATE group. PICOPREP was the most comfortable by organoleptic features. There was no significant difference in the quality of bowel cleansing between groups. CONCLUSION: PICOPREP is comparable by efficacy to other agents for the bowel cleansing, however it is better by organoleptic features and is safer than on sodium phosphate.

AIM: to clarify surgeon's preferences for the acute hemorrhoids conservative treatment. MATERIALS AND METHODS: an anonymous survey of 102 experienced colorectal surgeons was performed to reveal preferences in acute hemorrhoids treatment. Questionnaire in Russian included 8 items for assessment. RESULTS: the surgeons reported more than 30 different drugs for the local treatment of acute hemorrhoids. A majority of them consider necessity of systemic phlebotonics. The «Detralex» was most often prescribed. CONCLUSION: a majority of surgeons use effective drugs for acute hemorrhoids treatment. In some cases specialists has less knowledge on this problem.

AIM: to evaluate the significance of high-resolution anoscopy (HRA) in diagnostics of inflammatory and thrombotic changes in hemorrhoid piles and to assess the efficacy of micronized purified favonoid fraction (MPFF) in patients with inflammatory thrombotic changes of hemorrhoids according to HRA results in the preoperative conservative treatment of hemorrhoids. PATIENTS AND METHODS: a prospective cohort study included 77 patients with grade III chronic hemorrhoids. Patients were divided into 3 groups depending on the degree of development of inflammatory and thrombotic changes according to the HRA. The 3 group included patients with preoperative conservative treatment by MPFF. All patients underwent Milligan-Morgan procedure with further histological study of removed piles. RESULTS: it was found that the diagnostic sensitivity of the HRA in detection of inflammatory thrombotic changes was 91.3 % (CI=83.6-96.2 %), and diagnostic specificity - 40 % (CI=19-64 %). HRA diagnostic accuracy was 82.1 % (p=0.001). A 30 % decrease in the number of removed piles with moderate inflammatory thrombotic changes after MOFF therapy has also been revealed. CONCLUSION: HRA permits to determine the severity of thrombotic inflammatory changes, which is extremely importantfor the management of patients with acute hemorrhoids.

AIM: to evaluate results of transanal total mesorectal excision (TA TME) for rectal cancer. PATIENTS AND METHODS: Ninuty patients were included the prospective non-randomized study. Forty-five (50.0 %) of them underwent TA TME and 45 (50.0%) - conventional total mesorectal excision (TME). RESULTS: operation time was significantly higher in TA TME group: 276.4± 56.9 (190-400) minutes vs 188.0± 56.7 (100-310) minutes in open TME group (р=0.0001). The intraoperative complications rate was significantly higher in TA TME group: 7 (15.5 %) vs 1 (2.2 %) patient (р=0.05). No significant difference in postoperative morbidity was obtained: 18 (40.0%) in TA TME group vs 17 (37.7%) (р=1.0). Postoperative stay was lower in TATME group: 9 (7:14) vs 11 (10:14) days (р=0.04). Grade 2 specimen quality was detected significantly more often after TATME 26 (57.8 %) vs 15 (33.3 %) open TME (р=0.03), while Grade 3 specimens were more common after open procedure - 30 (66.7 %) vs 13 (28.9 %) TA TME group (р=0.0006). CONCLUSION: TA TME is a feasible procedure for rectal cancer patients. It demonstrated all benefits of minimally invasive technique, though learning curve is steep.

The treatment of pilonidal disease (PD) is extremely important now. Its incidence is up to 5% of the adults. PDtakes the fourth place among such coloproctological diseases as hemorrhoids, abscess and fistula-in-ano and anal fissure. The first experience of PD was described two centuries ago. During this period, various theories on etiology and pathogenesis of the disease were suggested. The western papers support the idea that the acquired genesis is a cause of PD. This point of view is the opposite to the countries of the former USSR, where pilonidal disease is considered as congenital pathology. Numerous procedures have been proposed because of the different theories of the etiopathogenesis if you take the point of view that the PD is a congenital disease it should be mentioned that the main goal of these methodsiselimination of pilonidal cyst with closure of the wound or without. If to consider PD as an acquired disease, the surgical break of pathogenetic mechanism is a key. Thisapproach includes: Bascom I, Cleft Lift, EPSiT procedures. Every procedure for PD has certain indications and contraindications. The aim of the review is to compare the main methods and determine their strengths and weaknesses. Unfortunately, today there is no "gold standard" in the treatment of pilonidal disease.