AIM. To evaluate the effectiveness of radiological control of original radiopaque markerspassage through the gastrointestinal tract in the diagnosis of chronic constipation. MATERIALS AND METHODS. In examination of 28 patients with chronic constipation syndrome method of passage the original radiopaque markers through gastrointestinal tract has been used. The markers were non-adhesive and insoluble compounds based on barium sulfate. RESULTS. The specifics of radiopaque markers passage in different severity of chronic constipation, as well as in abnormal architectonics and disposition of the colon in the abdominal cavity has been studied. We noted the peculiarities of radiopaque markers passage in two main patterns of motility disorders: colonic inertia and outlet obstruction. The speed of markers movement, their distribution in the gut, and the timing of the evacuation objectively reflects impaired evacuation function, moreover the method is easy to perform and interpret. CONCLUSION. This method expands the resources of diagnostic methods in chronic constipation and can be considered as an effective tool of functional diagnostics, allowing to make the differentiated approach to selection of the kind of the treatment, and in the case of surgical approach - to choose a range of resection.

THE AIM of the study was to develop a minimally invasive technique that does not have the disadvantages of traditional surgical treatment, does not have any restrictions in patients with external hemorrhoids as in HAL-RAR method. Technique that is more effective than HAL-RAR and isolated laser destruction methods, in the treatment of patients with chronic hemorrhoids stage II-III. MATERIALS AND METHODS. We developed a combined method of treatment of the patients with hemorrhoids, that unites artery ligation under the ultrasound control with Doppler effect and submucous subdermal laser destruction of internal and external hemorrhoids. We studied the safetiy and effectiveness of the developed method. The study included 100 patients with chronic hemorrhoids stage II and III, the patients were treated with the use of combined methodology HAL-laser (study group), the method HAL-RAR (1 control group) and closed hemorrhoidectomy linear stapler (control group 2). RESULTS. The analysis showed that the combined method HAL-laser has higher efficiency than the method HAL-RAR, and thus is as safe and well tolerated in patients. Its not so efficient compare to conventional hemorrhoidectomy because of the risk of a cosmetic defect, but does not increase the risk of recurrence of the disease, reduces the risk of complications and more endurable for the patients, it also allows to reduce the time of disability.

AIM. Improvement of treatment results in patients with the rectocele using of a two-level plastic of a pelvic bottom. METHODS. The plastic to a rectocele was carried out from the combined transvaginal and transrectal approach and consisted in sacrospinal-cardinal ligament, the colporrhaphy added transrectal «11 hours» with a mucopexy on height to 5 cm from the dental line. RESULTS. The remote results of treatment were tracked in terms from 12 months till 5 years after operation (a median of 3,5 years). In the studied group the «good» result was noted at 37 (75,5 %) patients, «satisfactory» and «unsatisfactory» - at 11 (22,4%) and 1 (2,0%) patients, respectively. Recurrence of a disease was taped at only 1 patient (2 %). CONCLUSION. The two-level pelvic plastic with the combined vaginal and transrectal access is associated with short operating time of 50 min., intraoperative blood loss about 150 ml and low perioperative morbidity.

AIM. To evaluate the effectiveness of antibiotic prophylaxis in closure of preventive intestinal stomas. MATERIALS AND METHODS. In a main (I-first) group included 99 patients who did not undergo antibiotic prophylaxis (ABP). In the control (II-second) group were 96 patients who underwent ABP by a single intravenous injection of 1,2 g of amoxycillin / clavulanic acid in 30 minutes before the operation. RESULTS. The overall incidence of complications in the main and control groups was 23 (23,3 %) and 27 (27,9 %), respectively (p=0,53). Among them, the surgical site infection (SSI) was the first place in the frequency of complications: in group I in 12 (12,2 %) in group II in 11 (11,4 %) patients (p=0,35 ). Postoperative diarrhea with frequency of stools 5 or more times per day in second place infrequency, but has evolved into two less in the main than in the control group - in 4 (4,0 %), and 8 (8.3 %) patients, respectively (p=0,212). Febrile fever was detected more frequently in the first group than in the second - 6 (6,1 %) and 1 (1,0 %) cases, respectively (p=0,06). Other complications were the paresis of gastrointestinal tract (p=0,76), bleeding from the formed anastomosis area (p=0,149), pneumothorax (p=0,324), cystitis (p=0,309) and lobar pneumonia (p=0,309). There were no statistically significant complications associated with one of two groups. CONCLUSION. The results of the study not prove the effectiveness of the ABP in patients undergoing closure preventive intestinal stoma. This does not allow us to recommend its routine use. The question of prophylactic antibiotics should be taken individually, considering all the possible risks.

There are presented normal values of anal pressure at rest and squeezing measured with non-perfusion water sphincterometer S4402 by MSM ProMedico GmbH. MATERIALS AND METHODS. 73 patients with colon adenomas before polypectomy underwent sphincterometry. All patients had no any complaints of fecal incontinence and outlet obstruction (0 points by Wexner incontinence scale and 0 points by outlet obstruction our clinic scale). Male were 28 (38,4%), average age 56,2± 10,2 years, female - 45 (61,6%), average age 54,9± 13,7 years. RESULTS. Male normal values: average rest anal pressure - 52,1 ± 19,8 mm Hg, maximum rest anal pressure - 60,3 ± 21,9 mm Hg., average squeezing anal pressure - 118,2± 41,5 mm Hg, maximum squeezing anal pressure -174,2± 56,8 mm Hg. Female normal values: average rest anal pressure - 37,1 ± 15,3 mm Hg. maximum rest anal pressure - 43,8± 15,5 mm Hg, average squeezing anal pressure - 75.1 ± 29.5 mm Hg, maximum squeezing anal pressure - 99,1 ± 39,7 mm Hg. CONCLUSION. There were detected normal values of anal pressure at rest and squeezing to use in approximate assessment of anal sphincter function. To perform comprehensive evaluation with this sphincterometer, elaboration of new software is required.

AIM. To estimate the short and long-term results of surgical treatment of colorectal cancer complicated by bleeding. MATERIALS AND METHODS. The results of 240 patients with colorectal cancer complicated by bleeding operated in Smolensk and Smolensk region in the period from 2002 to 2013 were analyzed. RESULTS. In the majority of cases radical treatment was one-stage surgery n=205 (85,4 %). CONCLUSION. Due to the high risk of recurrence of bleeding, patients with this complication of colorectal cancer are candidates for the tumor removing surgery.

Patients with colorectal cancer in the perioperative period, revealed pronounced changes of microbiocenosis of colon, which is characterized by changes in the quantitative and qualitative composition of microflora. It showed a significant inhibition of anaerobic microbial component mainly bifidobacteria and lactobacilli. As a result, saprophytic microbes multiply with highly resistant to drugs, acquire pathogenic properties. The most prominent representative of such microorganisms is a pathogenic strain of Clostridium difficile, often provokes the development of pseudomembranous colitis. Depending on the degree of dysbiosis held various schemes of conservative therapy, and in severe dysbiotic changes, including pronounced diarrhea associated Clostridium dificile -fecal transplantation.

The review respresents contemporary trends in treatment of diverticular disease. The basement of optimal decision making for these patients are clear diagnostic criteria, relevant diagnostic methods and comprehensive universal classification. The spectrum of therapies for diverticular disease includes conservative treatment for uncomplicated forms, percutaneous drainage for abscesses, resection for peritonitis. A possibility of primary anastomosis in case of resection for free perforation with or without protective stoma is discussed. Laparoscopic technologies for chronic complications of diverticular disease is a main trend to improve short, late and functional results in elective surgery.

Colon capsule endoscopy is a minimally invasive method for diagnosis of inflammatory and neoplastic diseases of the gastrointestinal tract. This study can be used as a screening method for detecting colon cancer, and in patients who either refused a colonoscopy, or it is contraindicatedfor one reason or another. The diagnostic efficiency of the method by using the second-generation colon capsule significantly increased.