AIM: to estimate the rate, causes and features of neurogenic bladder dysfunction in patients with rectal cancer after total mesorectumectomy.

PATIENTS AND METHODS: the results of surgical treatment of 103 patients with rectal cancer were analyzed in the light of immediate and long-term outcomes, who underwent total mesorectumectomy using traditional (56-54.4%) and laparoscopic (47-45.6%) technologies. In 20 (19.4%) of 103 patients, the course of the immediate postoperative period was complicated by the development of neurogenic bladder dysfunction. In order to study the frequency of neurogenic bladder dysfunction depending on the technique of mesorectumectomy, the patients were divided into 2 groups. Group 1 included 9 patients who underwent laparoscopic total mesorectumectomy. Group 2 included 11patients who underwent traditional (open) mesorectumectomy.

RESULTS: the study of the functional state of the bladder according to the flowmetric indicators revealed that the frequency of development of postoperative bladder dysfunction has a gender dependence. The frequency of neurogenic bladder dysfunction was 25% in men and 10,7% in women. It is shown that during 1 week and 6 months after surgery, the average urination rate tends to increase in women and decrease in men, regardless of the technique of total mesorectumectomy. In both groups, there was not a statistically significant decrease in the maximum volumetric velocity in both men and women within 6 months after surgery. At the same time, during this period, there was a decrease in the average rate of urination only in men, regardless of the technique of total mesorectumectomy. And in women, this indicator remained unchanged or slightly increased.

CONCLUSION: it is shown that a complex system of therapeutic measures, including drug stimulation of the detrusor and urethral sphincter, repeated catheterization of the bladder, as well as epicystostomy performed according to indications, allows adequate correction of bladder dysfunction after total mesorectumectomy in patients with rectal cancer.

PATIENTS AND METHODS: the retrospective study of clinical features and diagnostic tests results included 81 patients with idiopathic megacolon/megarectum (2004–2022). The diagnosis of megacolon/megarectum was confirmed with a barium enema, Hirschsprung’s disease was excluded based on anorectal manometry and (if needed) rectal Swenson biopsy. The QoL was assessed by IBSQOL questionnaire; clinical symptoms were assessed with a point scale.

RESULTS: the quality of life in patients with idiopathic megacolon has most affected energy (emotional and physical) and physical role (work/main activity). In univariate analysis the significant correlation was revealed between QoL and age, sex, rate of defecation without assistance, rate of integral parameters “abdominal discomfort” and “defecation difficulties”, duration of anamnesis, Wexner constipation scale rate and gut transit time (p < 0,05). In the same time, the presence or absence of constipation or anal incontinence (leakage), colon and rectum sizes (based on barium enema), parameters of defecografy and rectal compliance test have not correlated with a QoL. No significant difference of QoL in patients added to conservative treatment and operated after. Due to multivariate analysis (multiple linear regression) the age and rate of “abdominal discomfort” and “defecation difficulties” were only independent factors affected quality of life.

CONCLUSION: in terms of quality of life, idiopathic megacolon has the greatest impact on general tone and ability to perform basic professional activities. Independent factors that statistically significantly affect the assessment of quality of life are the age of patients and the severity of symptoms of abdominal discomfort and defecation disorders.

PURPOSE: to evaluate the effect of phlebotropic therapy on the effectiveness of surgical treatment of hemorrhoids.

PATIENTS AND METHODS: a comparative evaluation of the results of treatment of 406 patients with chronic hemorrhoids of stages III and IV was performed. With surgical treatment of hemorrhoids, standard conservative therapy was performed in 205 patients (group I) and 201 patients (group II) in the perioperative period, as well as at the rehabilitation stage, the standard program of drug treatment was supplemented with phlebotropic therapy using Detralex (1000 mg).

RESULTS: in group II patients, compared with group I patients, pain syndrome was stopped faster, quality of life and working capacity were restored, and the period of epithelization of the anal canal wound was shortened (21.4 ± 1.7 days versus 26.8 ± 2.1 days). This made it possible to increase the number of good and satisfactory results of surgical treatment of hemorrhoids from 82.4% to 91.5%.

CONCLUSION: outpatient surgical treatment of hemorrhoids of stages III-IV in combination with phlebotropic therapy can reduce the number of postoperative complications from 17.6% to 8.5% and increase the overall number of good and satisfactory treatment results from 82.4% to 91.5% (p < 0.005).

AIM: to evaluate the impact of dietary compliance in bowel cleansing for colonoscopy on the quality of the procedure.

PATIENTS AND METHODS: one thousand patients who scheduled for diagnostic colonoscopy were included in the prospective observation study. The quality of bowel preparation was assessed using the Boston scale. Neoplasms were detected and endoscopically evaluated. The optical verification of tumors was used to calculate the indicators of identified adenomas and polyps (ADR and PDR).

RESULTS: the quality of bowel cleansing by the Boston Scale was 6 (6; 8) points. One hundred eight (19.8%) patients did not follow the recommended diet. Poor preparation, which did not allow a total colonoscopy was found in 91 (9,1%) cases. The ADR was 37.4%, PDR — 43.4%. Logistic regression analysis showed that the noncompliance for diet recommendation was the only one significantly negative factor associated whit inadequate bowel cleansing.

CONCLUSION: the leading factor worsening the quality of bowel cleansing was non-compliance with the prescribed diet before the colonoscopy.

AIM: to evaluate the pilot program results for colorectal cancer (CRC) screening of the Sverdlovsk region (April — October 2021)

PATIENTS AND METHODS: a pilot program of three-stage CRC screening included at the first stage, the fecal immunochemical test was performed (patients aged 45–65 years). The second stage included questionnaire. According to the results of the questioning, patients with a positive fecal test and a potential risk of CRC underwent colonoscopy at the third stage.

RESULTS: at the first and second stages, 969 fecal immunochemical tests and questionnaires were performed. In 149 (15.4%) cases, a positive fecal test was detected. In 22 cases, employees with a negative fecal test were referred for colonoscopy according to the results of the questionnaire. At the third stage, 168 screening colonoscopies were performed. In 87 (51.5%) patients, epithelial colorectal neoplasia was detected, adenoma — in 57 (33.7%) cases, adenocarcinoma in 4 (2.4%), including T0 — in 3 patients, T2 — in 1 patient. In 182 cases, neoplasia occurred in 17.6% in the rectum and in 82.4% in the colon.

CONCLUSION: colorectal cancer (CRC) screening showed high efficacy.

AIM: to estimate effect of unimodal short preabilitation on functional reserves of patients, hospital stay, complication rate and quality of life.

PATIENTS AND METHODS: a single-centre, prospective, randomized study will include 128 patients undergoing colon resection for colorectal cancer. Patients will be divided into an intervention group that will receive 14 days of unimodal prehab (Group 1) and a control group that will not receive prehab (Group 2). Perioperative management of patients in both groups will be carried out in accordance with the guidelines for accelerated recovery after surgery (ERAS). The primary endpoint of the study will be the six-minute walk test (6MWT). Secondary endpoints will be: number of postoperative complications (by Clavien-Dindo), duration of the postoperative period, postoperative mortality, quality of life of patients and adherence of patients to the passage of the prehabilitation program.

DISCUSSION AND CONCLUSION: it is expected that short-term unimodal prehabilitation will improve the functional reserves of patients, reduce the duration of inpatient treatment and reduce the number and severity of postoperative complications, which can lead to a decrease in postoperative mortality and an improvement in the quality of life of patients. The adherence of the domestic cohort of patients to prehabilitation will be analyzed.

AIM: to assess late results of parastomal hernia repair using Sugarbaker’s technique modifications.

PATIENTS AND METHODS: prospective non-randomised study included 60 patients with parastomal hernia, which underwent surgery in 2013-2019. Patients were divided in two groups. The control group included 30 patients with “classic” Sugabacker method, the main group included 30 patients with Sugarbaker’s procedure added by suture of abdominal wall defect. Both groups were homogenous by age, gender, hernia size, type of primal disease and preoperative quality of life (EQ-5D-5L). The efficacy of the treatment was estimated by recurrence rate and quality of life 1 and 2 years after surgery.

RESULTS: the recurrence rate in the main group was significantly lower after 1 and 2 years (3 vs 13; p = 0.01). Quality of life in the main group was significantly higher after the first year of follow-up (the median of the weighted coefficient 0.92 vs 0.89; p = 0.04) and this trend has preserved 2 years after surgery.

CONCLUSION: suture of abdominal wall defect in Sugarbaker’s procedure for parastomal hernia reduces recurrence rate significantly and provides better quality of life.

AIM: to assess of the results of transmucosal laser ablation (TMLA) for internal piles and simultaneous elimination of external piles in patients with combined hemorrhoids of 2–3 stages.

PATIENTS AND METHODS: the retrospective study included 226 patients. TMLA of internal nodes with excision or destruction of external piles was performed in 136 patients (the main group) and 90 laser destructions of internal nodes only consisted the control group. The procedure was performed under local anesthesia on a Lakhta-Milon device with a wavelength of 1.47 μm with a power of 8.0 W. The operation time, the pain syndrome, its duration after surgery, the complication rate and the recurrence rate up to 18 months were estimated.

RESULTS: the operation time in the main group was 15.0 minutes (10 min in control group; p = 0.001), the pain intensity during procedure was determined by patients at 2.5 points of VAS (2.5 — in controls; p = 0.81). Postoperative pain was detected up to 6 days (5 days in controls; p = 0.44). Postoperative bleeding occurred in 4 (2.9%) (8 — in controls; p = 0.051), recurrence occurred in 3 (4.8%) patients after 12 months (1 patient in controls; p = 0.5).

СONCLUSION: TMLA has a good tolerability and good late results, which is the motivation for wide implementation for patients with hemorrhoids in outpatient basis.

AIM: to estimate the implementation of the original method that uses artificial intelligence (AI) to detect colorectal neoplasms.

MATERIALS AND METHODS: we selected 1070 colonoscopy videos from our archive with 5 types of lesions: hyperplastic polyp, serrated adenoma, adenoma with low-grade dysplasia, adenoma with high-grade dysplasia and invasive cancer. Then 9838 informative frames were selected, including 6543 with neoplasms. Lesions were annotated to obtain data set that was finally used for training a convolution al neural network (YOLOv5).

RESULTS: the trained algorithm is able to detect neoplasms with an accuracy of 83.2% and a sensitivity of 77.2% on a test sample of the dataset. The most common algorithm errors were revealed and analyzed.

CONCLUSION: the obtained data set provided an AI-based algorithm that can detect colorectal neoplasms in the video stream of a colonoscopy recording. Further development of the technology probably will provide creation of a clinical decision support system in colonoscopy.

AIM: to evaluate the effectiveness of first-line chemotherapy in patients with colorectal neuroendocrine cancer (NEC).

PATIENTS AND METHODS: a retrospective study included patients with metastatic colorectal NEC (2000-2020). The main analyzed parameter was the response rate to treatment according to the RECIST criteria, depending on the regimen used in the first line. The overall survival was additional parameter.

RESULTS: the study included 27 patients (13 with initial stage IV disease and 14 with progression after primary radical treatment). Ten patients in the 1st line underwent chemotherapy according to the EP scheme, 4 — XELOX, 2 — FOLFIRI, 2 — Irinotecan and Cisplatin, 1 — Samarium, 1 — Nivolumab, 1 — 5-FU-LV. Most often, the treatment effect (partial response or stabilization) was observed against the background of chemotherapy according to the EP scheme — in 60% of patients. The median OS was 7 months.

CONCLUSION: the use of chemotherapy according to the EP regimen is the preferred options for the treatment of metastatic colorectal NEC. The median OS in this group of patients remains extremely low, and new clinical trials are needed.

AIM: to evaluate the effectiveness of transabdominal ultrasound for complicated diverticular disease (CDD).

PATIENTS AND METHODS: a retrospective study included 108 patients with CDD. All patients had left-sided diverticula, while in the vast majority of patients, diverticula were located in the sigmoid colon.

RESULTS: transabdominal ultrasound was informative in 84.3% of patients; in 74.1% of cases (80 patients), diverticula were clearly identified with sizing, infiltration of the intestinal wall, fluid around the intestine, the presence of a fistulous tract in perforation, gas collections; 11 (10.2%) patients had indirect signs, such as diffuse hypoechogenic thickening of the intestinal wall, its infiltration, fistulous tract, liquid near the intestine, hyperechogenic structure of fat near the intestine, the presence of a paracolic abscess, absence or slowing down of peristalsis; 17 (15.7%) patients showed no changes, one had a false positive conclusion.

CONCLUSION: transabdominal ultrasound is an informative and non-invasive method for diagnosing complicated diverticular disease in urgent surgery.

The experience of complications treatment after surgery for Hirschsprung’s disease using posterior sagittal transanal approach is presented. It allows to obtain a sufficient overview of the main anatomical structures of the small pelvis in a “frozen pelvis” situation, helping to avoid their damage at the scar tissue changes.

AIM: to evaluate outcomes (overall survival, rate of surgical intervention due to complications of first treatment, 30-day mortality rate) of palliative primary tumor resection (PTR) followed by chemotherapy and chemotherapy/ radiotherapy (chemo/RT) alone in patients with asymptomatic or minimally symptomatic colorectal cancer (CRC) and synchronous unresectable metastases.

MATERIALS AND METHODS: a meta-analysis based on Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted on PubMed and Cochrane database. Odds ratio (OR) and 95% confidence interval (95% CI) were used as the treatment effect measure for comparing results. Combined overall effect measures were calculated for a random effect model. All analyses were performed using the Review Manager 5.3 software.

RESULTS: eighteen non-randomized studies, including a total of 2,999 patients (1,737 PTR and 1,262 chemo/RT) were identified. Gender, age, site of primary tumor and distant metastasis of patients were comparable between groups in all analyzed studies. Two-year (38.2% vs. 21.1%; OR 0.42; 95% CI 0.28–0.64; p < 0.0001) and 5-year (12.7% vs. 5.3%; OR 0.45; 95% CI 0.21–0.97; p = 0.04) overall survival rates were significantly higher in the PTR group than in the chemo/RT group. No significant differences in 30-day mortality rate between the two groups (1.7% vs. 1%; OR 1.92; 95% CI 0.79–4.68; p = 0.15). However, the rate of surgical intervention due to complications of first treatment was significantly lower in the PTR group comparing to the chemo/RT group (2.3% vs. 14.53%; OR 0.18; 95% CI 0.08–0.40; p < 0.0001). At the same time, one hundred and fourteen patients (13.8%; OR 0.19; 95% CI 0.09–0.40; p < 0.0001) in the chemo/RT group required surgery for symptoms associated with a primary tumor.

CONCLUSIONS: PTR in patients with asymptomatic or minimally symptomatic CRC and synchronous unresectable metastases significantly improves overall survival, allows to prevent surgical intervention due to complications related to primary tumor and is not associated with increased postoperative mortality rate comparing to systemic chemotherapy/radiotherapy as a treatment of first line. The current data are based on non-randomized comparative studies and data from early terminated randomized controlled trials (RCTs) and further well-designed RCTs are required.

Every year there is an increase in the number of patients with intestinal stoma, which leads to an increase in the incidence of parastomal hernias (PSH). More than 50% of ostomy patients develop a parastomal hernia two or more years after radical surgery. To date, there are many surgical options for PSH, however, a unified algorithm for choosing an operational technique has not been evolved.

The purpose of this review is to study modern surgical methods for the treatment of PSH and their late results, to determine the optimal approach and benefits.

The review of the literature showed that in all cases of surgical treatment of PSH it is necessary to use mesh implants. The optimal technique for PSH hernioplasty is the laparoscopic version of Sugarbaker due to the low risk of recurrence and technical simplicity. In patients with large and giant PSH or hernia recurrence, STORRM is the technique of choice; classical stoma transposition is not used due to the high risk of recurrence. The use of Pauli/ePauli technique demonstrates a low recurrence rate, but there are no late results in this category of patients.

AIM: to estimate the effectiveness of minimally invasive methods for treatment of chronic inflammation in pilonidal sinus disease by systematic review.

PATIENTS AND METHODS: fifty-two clinical trials were selected from 2,576 papers in databases for systematic review. It included the following methods: the fibrin glue, the sinusectomy, the video-assisted pilonidal sinus treatment, the laser coagulation and the chemical destruction using crystallized phenol or its solution. Regarding the last two methods, a meta-analysis was carried out.

RESULTS: the meta-analysis demonstrated the high effectiveness of phenol and laser coagulation for pilonidal sinus disease. When comparing the results of phenol use and excisional techniques, there was a significant difference in higher frequency complications rate after excisional techniques (HR 0.42; 95% CI: 0.05–3.71), while the recurrence rate was the same (HR 0.98; 95% CI: 0.45–2.16). The probability of recurrence was significantly higher than after excision techniques in compare with SiLaC (HR 4.02; 95% CI: 1.13 14.3, p = 0.03). However, there was no significant differences in complication rate after SiLaC and excisional techniques (HR 0.63; 95% CI: 0.29–1.34).

CONCLUSION: the chemical destruction and laser coagulation are the most effective methods for pilonidal sinus treatment.

This article analyzes the statistical data on colorectal cancer in Russia and in the world, including incidence, mortality and survival. The main pathways of colorectal cancer carcinogenesis, molecular subtypes and their influence on the difference in lesions of the proximal and distal large intestine are presented. The paper provides an overview of the leading chemotherapy agents and targeted therapy in colorectal cancer, as well as the main reasons for the development of therapeutic resistance, including changes in the cellular microenvironment of the tumor.

AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method.

METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method.

RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both.

CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.