AIM: To advance the rectal cuff mucosectomy method, reducing the risk of residual cuff it is. The aim of biopsy morphological study of rectal tissue were changes tracking dynamics, starting from the mucosectomy moment up to 1.5-2 years after the surgery. METODS: After colproctectomy and J-pouch forming the rectal cuff turnes inside out with mucous layer and high frequency electrothermal mucosectomy performes. Stapling IPAA and protective ileostomy are formed. This method of rectal cuff mucosectomy was performed in 13 patients. AH patients under went rectal cuff biopsy for dynamic pathological examination. RESULTS: During dynamic monitoring there were no clinical evidence of cuff it is in this patients. CONCLUSION: The new surgical treatment method of ulcerative colitis, including colproctectomy, stapled IPAA with protective ileostomy and high-frequency electro thermal mucosectomy of the rectal cuff, allows to completely remove the mucous the rectal cuff, thateliminatesriskofcuffi tisasresidualmanifestationsofulcerativecolitis, both in short- and long-term results. Functional results with out deteriorating.

AIM. To work up the optimal approach to the prevention and treatment of hemorrhoids in pregnant women in antenatal and postpartum women in the immediate postpartum period. MATERIAL AND METHODS. Based on the comparative results of treatment of hemorrhoids using topical and systemic medicinal drugs in 113 pregnant women determined the effectiveness of preventive and therapeutic tactics in respect of haemorrhoidal disease in pregnancy and the early postpartum period.. Treatment schemes designed for optimum efficiency and safety of treatment of acute hemorrhoids in this patient's category. RESULTS. The use of investigated schemes for treatment and prevention can significantly reduce the risk of exacerbation of the hemorrhoids and reduce the terms of relief of symptoms in pregnant and postpartum women. The experience of the Detralex (Daflon 500) demonstrates the effectiveness and good tolerability of this product when used in pregnant women for treatment and prevention of postpartum exacerbation of hemorrhoids.

The article describes the experience of application of minimally invasive methods of treatment chronic hemorrhoids stages II-III. The analysis of the effectiveness of methods and stand-alone when combining methods on the basis of the treatment and dynamic follow-up of 493 patients. The analysis of the indications for use, clinical effectiveness and disadvantages of minimally invasive techniques. Substantiated the clinical efficacy of venotonics (micronized flavonoid fraction) in the pre - and postoperative treatment in the application of minimally invasive methods of treatment chronic hemorrhoids. Identified the need for a differentiated approach to the definition of indications and choice of a method of minimally invasive surgery depending on the clinical picture of the disease (type, stage, presence of inflammatory changes, bleeding).

AIMS. To investigate the efficacy of combination therapy using bone marrow-derived mesenchymal stromal cells (MSC) and Infliximab (IFX) to achieve «deep remission» in patients with luminal Crohn disease (CD). METHODS. Our study included 72 patients (19-62 y old) (Ме=29) with luminal CD. Patients ini group (n=21) received standard 5-aminosalicylic acid (5-ASA) and glucocorticosteroids (GCS) therapy in combination with MSC. Patients in 2 group (n=32) were prescribed anti-cytokine therapy IFX. Patients in 3 group (n=19) received MSC and IFX. RESULTS. Clinical, immunobiological and hystological results (C-reactive protein-CRP, fecal calprotectin-FCP, Gebs scale) showed more significant decrease of local and systemic inflammation activity in 3 group of patients. During 3-year follow-up we observed the longer duration of remission in patients, received MSC and IFX compared to 1 group of patients (р=0,04) and 2 group of patients (р=0,038). CONCLUSIONS. Combination therapy of bone marrow-derived MSC and IFL provides «deep remission» in patients with luminal CD and has higher prognostic value in duration of CD remission period.

The results of research of anatomy of rectal arteries by an angiography method are presented. AIM. To study “in vivo” specific features of anatomy of rectal arteries in rectum blood supply and to justify the usefulness of endovascular interventions in patients with rectal cancer. MATERIALS AND METHODS. The analysis angiograms of 123 patients of various age and sex is carried out. RESULTS. The superior rectal artery is the main source of rectum blood supply. Middle rectal arteries are an additional source. In vivo bilateral asymmetry with primary development of the left vessel is observed.. The inferior rectal arteries are visualized less than in one third part of cases. Rectal artery have a extensive network of anastomoses with other pelvis vessels. CONCLUSIONS. The results justify the anatomical possibility and feasibility of endovascular methods in rectal cancer therapy considering individual features of rectum blood supply.

The aim of this work was to analyze early postoperative complications after restoration of bowel continuity in patients which undergone Hartmann procedure for tumor intestinal obstruction and to identify risk factors of complications. 192 patients were included in retrospective study. Early postoperative complications occurred in 18 (9,4%) patients. Univariate analysis showed that COPD increased the risk of complications in 1,7 times (p=0,044), history of septic complications at the previous surgery - in 4,3 times (p=0,011), the third grade of severity of intraperitoneal adhesions in comparison with the 1st grade - in 9,7 times (p=0,001). Multivariable analysis showed that the hazard ratio in patients with complications during the first operation was 4,3 (CI 1,7-23,3, p=0,021), and in patients with the 3d degree of adhesions of 7,5 (CI 1,3 to 15,6, p=0,001).

AIM to assess the frequency of manuriton during preoperative period in elderly and senior patients with colorectal cancer. PATIENTS AND METHODS. The results of nutritional status in 38 patients before surgery were analyzed. Anthropometric (BMI, arm circumference, triceps skinfold thickness) and laboratory (blood serum protein, albumin, transferrin and total count of lymphocytes) parameters were used. RESULTS. The average value of parameters were declined only for total count of lymphocytes - 1,5 thousand per μl SD - 0,5 (р<0,0001). Malnutrition was diagnosed by lymphocytes in 71% (27) and triceps skinfold thickness in 50 % (19). BMI showed hypotrophy only in 2 patients. Overall malnutrition was diagnosed in 31 of 38 cases (82%). CONCLUSION. Only complex study of anthropometric and laboratory parameters could prove preoperative malnutrition in elderly and senior patients with colorectal cancer.

90 patients (female 72 (80%), male 18 (20%), mean age 43,6±16,5 y.o.) with functional disorders of defecation (dyssynergic defecation and inadequate propulsion) were included in the study. All the patients conformed the Rome III (2006) criteria for functional constipation. Highresolution anorectal manometry (HRAM) procedures (London protocol) were performed using Solar GI system (MMS, The Netherland) with 8-channel water-perfusion catheters. All the patients underwent a course of biofeedback therapy for obstructive defecation (Urostim, Laborie, Canada). The course consisted of 10 daily 30-minutes long sessions. Treatment efficacy was evaluated after the completion of biofeedback therapy according to the control HRAM. CONCLUSIONS. Biofeedback is the method of choice for treatment of patients with obstructive defecation syndrome with pelvic floor dyssynergia and spasm of m.puborectalis. At the same time biofeedback therapy is ineffective in patients with type III of manometry pattern and in patients with an inadequate propulsion.

One hundred seven patients had reconstructive surgery after previous Hartmann procedure performed at emergency presentation. Between 2000-2014 there were 46,19% operation performed from of midline laparotomy, 39,08% from local access, and 14,72% using laparoscopy assisted method. Between 2013-14 open approach was used in 16,66% of cases, in 14,63% form local access and 69,04% of the patients were operated using laparoscopy assisted method. LAS operations - at. The choice of restoring the intestinal continuity after Hartmann procedure is under development, as the trend towards mini-invasive surgery exists.

Ischemic bowel disease results from an acute or chronic decline of the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis (IC) or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease, congestive heart failure and recent aortic or cardiopulmonary bypass surgery are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its polymorphic aspects and the general lack of statistical data. In this paper, we present two cases of patients who were monitored in our clinic. For these patients, we encountered with pivotal changes in the clinical pattern. These evolutions is particularly rare in common clinical practice, and cases are exemplary because it raises discussions about the nature of the condition and therapeutic decisions that should be made at every stage of the disease.