AIM: to compare the effectiveness of different methods of total mesorectumectomy (TME).

MATERIALS AND METHODS: the systematic review performed in accordance with PRISMA practice and recommendations.

RESULTS: Forty-one papers were included in the analysis. Fourteen studies were for transanal total mesorectumectomy (TA TME) (n=480) compared with laparoscopic (LA TME), 26 – for LA TME vs open (n=6820), 1 – for open vs TA TME. There was no significant difference between open TME, LA TME and TA TME in grade 3 quality of mesorectumectomy by Quirke. The positive circular resection margin (CRM) is less often in TA TME group, then LA TME (OR=2.58, CI 1.34-4.97, p=0.005). There was significantly lower positive CRM rate in LA TME then open TME (OR=0.73, CI 0.63-0.85, p<0.0001). There were no significant differences in postoperative complications rates between LA TME and TA TME (p=0.72). Network meta-analysis showed less postoperative complications followed LA TME than open TME (OR=0.75, CI 0.65-0.84).

CONCLUSION: TA TME is comparable with laparoscopic and open TME in short term results. Rates of positive CRM, the quality of Grade 1 mesorectal excision, the conversion rate, the postoperative urinary dysfunction, may have better results in TA TME.

AIM: to demonstrate the first Russian experience with the use of tofaciminib (TOFA) for the treatment of moderate and severe UC in real clinical practice.

PATIENTS AND METHODS: eighty-five patients with UC (aged 41.38±14.69 years, average disease duration 9.55±5.27 years, mild UC – 3.5%, moderate UC – 41.2%, severe – 52.9%, acute severe UC – 2.6%), resistant to corticosteroid therapy (36.5%) and biological agents (61.2%), were prescribed with TOFA at an induction dose of 10 mg 2 times a day, followed by a decrease in the dose to a maintenance dose (5 mg 2 times a day). Early clinical response, clinical and endoscopic remission, prevalence and dynamic of extraintestinal manifestations were assessed at 8 and 12 weeks of treatment, as well as safety and tolerability.

RESULTS: Sixty-eight (80.0%) patients completed induction treatment with TOFA for 8 weeks, other patients continue to receive TOFA. A quick response within one week was detected in 41 (50.6%) patients, on average, on the 5th day of therapy. At the end of induction, 52 (76.5%) patients achieved clinical remission, 3 (4.4%) achieved a clinical response, 13 (19.1%) patients showed no positive changes. Of the 53 patients observed over 12 weeks, 41 (77.4%) had clinical remission, 6 (11.3%) had clinical improvement, and 6 (11.3%) patients had no response to the treatment. The changes of extraintestinal manifestations were positive: 55.2% of patients at week 8 and 77.8% of patients at week 12 showed clinical improvement, mainly in relation to the joint syndrome. One episode of herpes zoster infection, one case of anemia, were identified dur-ing 12 weeks of follow-up.

CONCLUSION: TOFA in UC is effective in achieving a rapid clinical response, clinical remission and mucosal healing in patients who do not adequately respond to therapy with basic as well as biological drugs. Tofacitinib is an effective and safe therapeutic option for this challenging patient population.

AIM: analysis of approaches to the treatment of different stages of hemorrhoids to clarify what factors provides the choice of a method of treatment modality.

PATIENTS AND METHODS: the study is based on the analysis of clinical and instrumental examination of 804 patients with stage I-IV hemor-rhoids. It included 412 (51.2%) females aged 19-83 (44.8±13.2) years.

 RESULTS: micronized purified flavonoid fraction (MPFF) in combination with dietary fiber intake and topical treatment effectively reduces the severity of the main clinical manifestations of hemorrhoids. Due to this, in 200 (24.8%) cases of stage I-IV hemorrhoids, doctors chose conservative treatment in connection with the achieved positive clinical effect. The combination of systemic phlebotropic therapy (MPFF) with minimally invasive and surgery was carried out in 355(44.2%) and 249 (31.0%) cases of stage II-IV hemorrhoids, respectively. Minimally invasive procedures were performed in patients with a minimal changes of external hemorrhoidal piles. In 210 (54.7%) cases, surgery was performed in patients with a significant changes of external hemorrhoidal piles.

CONCLUSION: multimodal treatment of hemorrhoids with the use of MPFF, shows its effectiveness for elimination of the main clinical manifesta-tions of the disease in hemorrhoids stage I-II. Patients with stage III and IV hemorrhoids require the use of a minimally invasive procedures and excisional surgery. The choice of the method is influenced not only by the hemorrhoid stage, but also by the anatomical features. The use of MPFF allows to remove the acute changes and to select an optimal method of minimally invasive or surgical procedure individually.

AIM: to estimate efficacy of local use of fluocortolone pivalate combined with lidocaine for postoperative pain after excisional hemorrhoidectomy.

PATIENTS AND METHODS: two-hundred patients were included in retrospective study. All patients underwent excisional hemorrhoidectomy. Patients were divided in two groups, each group included 100 patients comparable in demographics, hemorrhoids stage. Traditional postoperative systemic pain relief was used in both groups and included NSAIDs and opioid receptor antagonists. The main group included patients with postoperative additional local use of fluocortolone pivalate in combination with lidocaine in operative theatre, every day after during postoperative control examination and after each defecation up to 7 days after surgery. The pain intensity was estimated using visual analog scale (VAS).RESULTS: on the 1st day after surgery pain was less intensive in the main group (1.57 vs 3.24; p<0,05), as well as on the 3d day (0,91 vs 2.48; p<0,05) and on 7th day (0.63 vs 1.12; p<0,05).

CONCLUSION: local use of fluocortolone pivalate combined with lidocaine reduces postoperative pain twice.

AIM: to present clinical variability of perianal infection (PI), developed in the debut of oncohematological disease and to determine the factors that impede PI relief and time of antitumor treatment initiation, as well as the causes of complications during chemotherapy (ChT).

PATIENTS AND METHODS: the analysis included 8 patients with an infectious process in the perianal region developed in the debut of hemoblastosis and aplastic anemia (before ChT).RESULTS: in 5 of 8 patients there was a long time between start of PI and the start of ChT for hemoblastosis, from 18 to 49 days. The impediment for a favorable time to start ChT were not clarified diagnosis of hemoblastosis (acute myeloid leukemia – 2 cases, multiple myeloma – 1, lymphoma – 1) and the ongoing infectious process in patients with severe granulocytopenia (GCP). Usually undetected hematological malignancies were observed in patients with compensated data of haemogram. Complications during ChT were associated with recurrence of PI in the area of surgery (palliative drainage of anorectal abscess and fistula-in-ano) and of the sepsis with persisted inflammation in the postoperative wound on the background of GCP.

CONCLUSION: PI is one of the infectious complications peculiar for the debut of oncohematological disease. Therefore, a general blood test with leukocyte formula should be performed before surgery in all patients with paraproctitis to exclude hemoblastosis. The unknown diagnosis of hemoblastosis and the ineffectiveness of surgical treatment of paraproctitis in patients with severe GCP were the main reasons for the delay in the beginning of antitumor treatment in this study. Persistent infection (fistula-in-ano) and the persistent inflammation in the wound on the background of the GCP has resulted in the recurrence of PI and sepsis during chemotherapy.

The case report of the onset of acute severe ulcerative colitis (ASUC) in a young, previously healthy patient. The UC was revealed department of the infectious disease in general hospital, a proper conservative treatment was started but was ineffective. The patient was taken to the colorectal surgery unit of the tertiary referral center. His status was very poor including metabolic changes and dehydration, anemia, thrombocytopenia, systemic inflammatory response syndrome. Despite intensive therapy, the condition impaired and massive intestinal bleeding recurred. Urgent colproctectomy with end ileostomy was performed. Pathomorphological study verified the diagnosis of ulcerative colitis – highly active inflammation involving the submucosal and muscular layers of the intestine with multiple crypt abscesses. The patient was discharged 2 days after surgery. Follow-up was 3.5 years, patient in good condition without restrictions.

The paper presents a clinical case of a rare stromal colon tumor in a patient previously operated for breast cancer. The patient with a rapidly growing abdominal tumor of unknown origin underwent tests in the department of coloproctology. According to ultrasound and CT examina-tion, the lumpy formation with large size and low mobility, compressing the surrounding organs and probably coming from the colon, has been revealed. The removal of the tumor coming from the sigmoid colon with segmental resection anastomosis was performed. The postoperative period was uncomplicated, patient discharged from the clinic 7 days after surgery. Immunohistochemical examination of the tumor showed Gastrointestinal Autonomous Neurogenic Tumor (GANT) – a variant of GIST. Surgery for rare mesenchymal tumors is better in the coloproctologi-cal units with sufficient skills of surgeons. The multidisciplinary approach is necessary in such cases.

AIM: to evaluate of efficacy of fluorescence angiography (FA) in reducing the anastomotic leakage (AL) rate after colorectal surgery in meta-analysis.

SEARCH STRATEGY: PubMed were searched up to May 2019 for studies comparing fluorescence imaging with standard approach. The primary outcome measure was colorectal anastomotic leakage (AL) rate. The Newcastle-Ottawa scale was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data.

RESULTS: Two thousand four hundred and sixty-six patients from 7 non-randomized studies and 1 randomized study were included. Fluorescence imaging significantly reduced the AL rate in patients after colorectal surgery (OR 0.58; 95%CI 0.39-0.85; p=0.006) and after rectal cancer surgery (OR 0.28; 95%CI, 0.14-0.55; p=0.0002). A limitation of this meta-analysis is the inclusion of only one randomized study.

CONCLUSION: Fluorescence angiography with indocyanine green is a method of preventing of leakage of colorectal anastomosis. The results of randomized clinical trials are needed to confirm the effectiveness of this technique.

Rubber band ligation is one of the most common and effective minimally invasive methods of treatment of chronic hemorrhoids. An analysis of the experience gained in the use of latex ligation makes it possible to evaluate the advantages and disadvantages of this technique and suggest new options for its implementation. One of the main advantages of rubber band ligation is the radicality of the procedure, which provides the closed removal of internal hemorrhoid piles, which makes it possible to standardize the widespread use of this technique in outpatient practice. When performing the procedure, tool kits of various designs are used, methods of one-stage and multi-stage ligation are used, various technical options are available for applying latex ligatures that affect the pathogenetic factors of hemorrhoidal disease. Optimization of options for the use of rubber band ligation allows to expand the range of use of this technique and provides a rational choice of individual approach.