AIM: to reveal fistula healing incidence after application of FiLaC™ technique and factors that can affect it. MATERIALS AND METHODS: when searching electronic medical databases for publications that evaluated the results of the FiLaC™ technique in the treatment of anal fistula, 6 studies were selected, corresponding to the search queries. The search was carried out taking into account the principles of systematic literature reviews and meta-analyses (PRISMA). The time interval for searching publications was between 2011 and October 2018. In the publications included in the analysis, the following parameters were evaluated: general characteristics of the study groups, technical aspects of the FiLaC™ technique, the site of the fistula in relation to the anal sphincter, the option of closing the internal fistula, the incidence of healing and recurrence of fistula, the duration of the follow-up period after surgery, re-operated cases of fistula recurrences. RESULTS: taking into account the data obtained in the analysis of the selected studies, the mean incidence of fistula healing was 64.5% (40.0-88.2)%. It was found that the only factors that can be used to assess their impact on the incidence of fistula healing were: the gender and the variant of the fistula site in relationship to the anal sphincter (transsphincteric/extrasphincteric). Statistical analysis and evaluation of the odds ratio revealed no effect on the treatment result of the above parameters. CONCLUSION: the analysis of the data showed that FiLaCis mainly indicated for the treatment of patients with extrasphincter and transsphincteric anal fistulas. The method can be recommended as a sphincter-sparing treatment in patients with initially weakened anal sphincter function and, consequently, with a high risk of anal sphincter insufficiency in the application of traditional techniques. Further evaluation of the treatment results in the treated period and their comparison with the results after other variants of coagulation of the fistula walls is required to obtain a clearer understanding of the effectiveness of the FiLAC technique.

AIM: transanal endomicrosurgery (TEM) is the method of choice for local excision of rectal cancer. The presented series of patients is collected prospectively and is the largest of the published in the Russian medical periodicals. PATIENTS AND METHODS: six-hundred patients [average age ±σ 59.8±9 (31-90) years old; 375/600 (62.5%) – women]with rectal adenomas and adenocarcinomas, who underwent TEM in 2011-2019. RESULTS: the mean size of the removed tumors was 3.4±1.5 cm (0.5-10.0). R0 resection was performed in 571/600 (95.2%) of the cases. The complication rate was 3.6% (22/600). Pathomorphological study of the removed specimens revealed adenoma in 450/600 (75.0%) patients, adenocarcinoma in 150/600 (25.0%) cases. The mean time of observation of patients with adenomas was 38.4±25.1 months, with adenocarcinomas – 33.4±23.8 months. The rate of local recurrence in adenomas was 4.5%. Loco-regional recurrence of adenocarcinoma pT1 after TEM was revealed in 6.8% of patients and 30% of pT2 patients without adjuvant treatment. CONCLUSION: TEM is an effective and safe method of treatment of rectal adenomas. With rectal cancer, a thorough selection of patients is required.

AIM: to evaluate late results for patients that had open and laparoscopic total mesorectumectomy (TME) surgery for rectal cancer. PATIENTS AND METHODS: prospective cohort study included 103 patients aged from 20 to 70 years with rectal cancer. Patients were divided into 2 groups: the 1st group included 47 patients after laparoscopic TME (LTME) and the 2nd group included 56 patients after open one (OTME). All tumors were adenocarcinomas. Late results were assessed by actual and disease-free 3- and 5-year survival in 97 (94.2%) patients. RESULTS: local recurrence rate after OTME and LTME was 11,5% (6 patients) and 11,1% (5 patients) (p>0.05). Distant metastases occurred in 4 (7,7%) and 3 (6,7%) cases, respectively (p>0.05). The actual survival after LTME was 80.0% (81.8% after OTME, p>0.05), the disease-free 3-year survival rate was 56,7% (60.6% after OTME, p>0.05), 5-year survival was 31.6% (31.8% after OTME, p>0.05). CONCLUSION: no significant differences were found between laparoscopic and open approach for rectal cancer in local recurrence rate and survival.

AIM: to reduce antibiotic resistance of infectious agents in colorectal surgery using optimal antibiotic therapy. PATIENTS AND METHODS: single-center interventional study with retrospective control has been done. Start point of intervention was January 2017, when it was provided direct administrative control of perioperative antibiotic prophylaxis protocols and empirical antibiotic therapy. The study included 200 patients after colorectal surgery in 2016-2017. Patients divided in two groups: in 2016 y – control (A), in 2017 – interventional one (B). RESULTS: significant decrease was detected in total antibiotic use from 16.1 to 12.2 defined daily dose (DDD) and in duration of antibiotic prophylaxis from 5.5 to 1.9 days (p<0.001). Incidence of infection caused by multi-resistant strains reduced from 84.3% to 50% (p<0.001). Analysis of etiology septic complications in colorectal patients showed a decrease in the number of Enterobacteriales, producing extended-spectrum beta-lactamases (ESBL) from 33.3% to 11.8% (р<0.01). The incidence of carbapenem-resistant Klostridium pneumoniae reduced from 7.8% до 0%, р=0.031. ESKAPE group pathogens decreased from 24 (47.1%) to 12 (17.7%), р<0.001. No difference in postoperative infectious morbidity between groups was detected (32.9% vs 31.0%, р=0.88). Incidence of antibiotic-associated diarrhea decreased from 5% to 0% (р=0.03). CONCLUSION: direct control of antibiotic prophylaxis protocols and empirical antibiotic therapy allowed to decrease the rate of antibiotic use and to decrease rate of infection complications caused by antibiotic resistance strains.

AIM: to obtain and investigate the activity of silver nanoparticles stabilized with arabinogalactan in relation to clinically relevant strains of filmforming microorganisms. MATERIALS AND METHODS: silver nanoparticles were obtained by reduction from silver nitrate in the presence of arabinogalactan with additional stabilization with dioctyl sodium sulfosuccinate. The shape and size of the nanoparticles were determined by the method of transmission electron microscopy, the zeta potential by the method of electrophoretic light scattering. The study of the effect of the nanoparticles on biofilm formation was carried out on 17 clinically relevant strains of bacteria isolated from blood culture and the clinical biomaterial of postoperative patients. RESULTS: the silver nanoparticles with an average diameter of 11.4 nm and a zeta potential of –24 mV were obtained. The minimum inhibitory concentration of the nanoparticles in relation to planktonic form of bacteria was 120 µg/ml; the use of the drug at a concentration of 100 µg/ml reduced the amount of CFU by 7 orders of magnitude compared with the initial culture. The study of the effect of silver nanoparticles on the formation of biofilms showed that, in the presence of the drug, the growth of biofilms was significantly reduced; at a drug concentration of 150 µg/ml, the growth of bacterial films was completely suppressed. Incubation of the formed daily biofilms with the silver nanoparticles in the concentration range from 150 to 120 µg/ml for 48 h resulted in the partial or complete destruction of the biopolymer matrix. CONCLUSION: the studied preparation of silver nanoparticles has a great potential for use in the treatment of infectious diseases caused by biofilm forming microorganisms.

AIM: to evaluate the strength properties of the colorectal tumors in patients with colorectal cancer with acute bowel obstruction. MATERIALS AND METHODS: twenty-six resected specimens with colorectal cancer complicated by acute bowel obstruction were studied using histological and immunohistochemical methods. Following criteria have been assessed: tumor histological structure and differentiation, invasion depth, bowel wall thickness in central and peripheral tumor parts, ratio of necrosis, proper tumor tissue and preserved muscular and serosal layers. RESULTS: in tumors of 3.9-5.5 cm long no significant differences were detected between volume ratio of the preserved muscle tissue, fibrous tissue and necrotic tissue in central part of tumors compared with peripheral one. In tumor >5.5 cm long the volume ratio of proper tumor and necrotic tissue was significantly higher in tumor central part compared to peripheral one. CONCLUSION: endoscopic stenting in colorectal cancer with acute bowel obstruction is more safety if tumor length ≤5.5 cm. The tumor perforation is highly likely when tumor length >5.5 cm

Crohn's disease (CD) is a complex, chronic recurrent disease with transmural, segmental, granulomatous inflammation in all parts of the gastrointestinal tract with high risk of local and systemic complications. The disease is progressive, despite a wide range of modern conservative and surgical approaches. One of the most common causes of surgery for CD is strictures, which are result of prolonged, non-specific inflammation and later cicatricial changes in the intestinal wall. The occurrence of strictures is a serious clinical problem, due to the lack of effective methods of diagnosis and treatment. In fact, there are two type of surgery – resection of the affected area and organ-saving procedure. At the same time, when performing extensive resections of the small bowel, the patient loses a large area of absorption surface, which often leads to the short bowel syndrome. Recently, the majority of foreign experts prefer organ-saving procedure – strictureplasty. In this paper, we present a case of successful application of this procedure for complicated form of Crohn's disease.

Crohn's disease and multiple myeloma are pathological entities, the development of which, at least in part, is associated with an immune disregulation. Crohn's disease is often combined with extra-intestinal manifestations from different organs and systems (joints, skin, eyes, etc.). Hematological extra-intestinal manifestations, such as myelodysplastic syndrome, aplastic autoimmune anemia, autoimmune thrombocytopenia, B12-deficiency anemia are less common. The list of extra-intestinal manifestations of Crohn's disease is constantly expanding, including more and more descriptions of the combination of Crohn's disease with diseases of the blood system. The paper presents a rare clinical case of a combination of Crohn's disease and multiple myeloma. The female patient is 53 years old. In 1993 ulcerative colitis was diagnosed and she received Sulfasalazine 4gr per day. In 2015, with the recurrent attack, the diagnosis was transformed towards Crohn's disease basing on colonoscopy. She received steroid therapy. In 2018 the control examination revealed an increase in the level of total protein to 117gr/l. Patient underwent a sternal biopsy. Multiple myeloma was diagnosed on the basis of a myelogram.

This case report describes a rare condition – colon duplication in patient in adulthood, which underwent surgery for benign abdominal tumor. The diagnosis was established after histological study of the resected specimen.

Extraintestinal manifestations are found at least in a quarter of patients with Crohn's disease. In contrast to eyes lesions, joints and skin, epididymoorchitis caused by Crohn's disease is extremely rare and is described in few papers. However, orchitis and epididymitis are described in another autoimmune disease, ankylosing spondylitis and, although the incidence of asymptomatic orchitis in ankylosing spondylitis is unknown, it is often diagnosed during examinations for male infertility. A clinical case report of a 26-year-old patient suffering from Crohn's disease with extraintestinal manifestations in the form of orchiepididymitis is presented. While receiving treatment in the urological unit, the patient underwent several procedures, including a right-side orchiectomy, but the inflammatory process progressed with the risk of losing the only remaining testicle. Only after ileocecal resection for the penetrating Crohn's disease with ileosigmoid fistula and following biological therapy, it was possible to achieve remission and preserve a single testicle.

Infectious complications in colorectal cancer surgery is one of the major problems in postoperative complications structure. The frequency of the latter is 5-22%, and in 5-20% of cases such complications lead to death. It should be noted that the development of postoperative complications leads to a decrease in the quality of life of patients, general and relapse-free survival of patients operated on for colorectal cancer. One of the promising ways to diagnose postoperative infectious complications after surgery is to assess the level of biological markers of plasma inflammation. It can be used to identify patients with a high probability of infection and be an indication for earlier additional methods of diagnosing complications. Currently, biomarkers that are used for early postoperative infection detection include increase in the leukocytes level in peripheral blood, CRP, PCT, CD64 neutrophils and others. Despite the large number of studies, the question of the role of these biomarkers in postoperative infections diagnosis in the patients who under went colorectal cancer surgery remains unclear.

Crohn's disease (CD) is a chronic autoimmune disease of the gastrointestinal tract, which mainly affects young people of productive age. Until now, patients with this disease cannot be cured with by conservative therapy or surgery. The effectiveness of drugs for CD is limited, and their use is often accompanied by adverse events. All this creates a need for new drugs, fundamentally different in the action, with high efficiency and a good safety profile. The review is dedicated to a new biological agent for the treatment of CD blocking interleukins 12 and 23, which are involved in the pathogenesis of inflammation in inflammatory bowel diseases. This review presents the data of phases 2 and 3 clinical trials of the agent and the data obtained in real clinical practice, allowing to conclude about the efficacy and safety, as well as its place in the treatment algorithm for CD.