To ASSESS effectiveness of total neoadjuvant therapy (TNT) for patients with rectal carcinoma.

Patients and methods: patients with histologically proven rectal carcinoma were randomly assigned in two groups: in the TNT group after the neoadjuvant CRT 50-54 Gy with capecitabine 3 consolidation courses of XELOX were done, in the CTR group - conventional neoadjuvant CRT 50-54 Gy with capecitabine. At the end of the treatment, effect was assessed by MRI using the mrTRG scale. For patients with a full clinical response, who have refused surgery, «watch&wait» approach was used. For other patients effect of neoadjuvant therapy was evaluated by pathomorphological study using the Ryan scale. The primary endpoint of study was the complete response rate (clinical and pathomorphological). Secondary endpoints of study: frequency and structure of intraoperative and postoperative complications, the rate of grade 3–4 toxicity of radiotherapy and chemotherapy, R0-resection rates. The study was registered on the ClinicalTrials.gov (NCT04747951)

RESULTS: between October 2020 and October 2023, 183 patients were enrolled in the randomized study: 91 patients in the TNT group and 92 patients in the CRT group. At median (Q1, Q3) follow-up period 24 (14; 28) months, complete clinical response observed in 23% (14/60) of TNT patients and in 7% (5/71) of THL patients (p=0.008). The pCR rate was 20% (9/45) in the TNT group and 8% (5/66) in the CRT group (p=0.05). The frequency of development of toxic reactions of degree 3-4, the frequency and structure of intra- and postoperative complications, as well as the frequency of R0 resection of the group did not differ statistically significantly. The total rate of Grade 3–4 toxicity, rate of intra- and postoperative complications, R0-resections rate did not differ between two groups.

CONCLUSION: preliminary results of a randomized study demonstrated the effectiveness and safety of total neo-adjuvant therapy in rectal cancer treatment.

OBJECTIVE: to compare the immediate and long-term results of endoscopic mucosal resection with a circular incision (C-EMR) and endoscopic submucosal dissection (ESD) in the treatment of patients with large benign epithelial neoplasms of the colon.

PATIENTS AND METHODS: a prospective randomized comparative study was conducted from November 2020 to July 2022, included 103 patients with benign epithelial neoplasms of the colon ranging in size from 20 to 30 mm. The C-EMR method was used in 52, ESD - 51 patients.

RESULTS: the removal of the tumor by the C-EMR method required statistically significantly less time, compared with the ESD method – 30 and 60 minutes, respectively (p<0.001). Intra- and postoperative complications occurred in 13(23.7%) patients in the C-EMR group and in 12(23.5%) patients in the ESD group. The most frequently reported complication was postcoagulation syndrome in the main and control groups – in 9(17.3%) and 11(21.6%) cases, respectively. It was found that the difficult location of the tumor (OR=18.3; p=0.01) and intraoperative complications (OR =37.5; p=0.04) are independent conversion factors of endoscopic intervention. The frequency of tumor removal in a en bloc and achievement of negative resection margins (R0) in the main and control groups did not significantly differ – 47(90.4%) and 49(96.1%) (p=0.4) and 40(76.9%) and 45(88.2%) (p=0.2), respectively.

CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe operation comparable to endoscopic submucosal dissection, and can be the method of choice for benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In addition, the duration of the operation using the C-EMR method is two times less than using ESD.

AIM: to identify risk factors of sigmoid volvulus in patients with idiopathic megacolon/megarectum.

PATIENTS AND METHODS: the retrospective study included 151 patients with idiopathic megacolon/megarectum (2002-2023). The diagnosis of megacolon/megarectum was confirmed with a barium enema. Hirschsprung’s disease was excluded after anorectal manometry and (if needed) rectal wall biopsy by Swenson.

RESULTS: forty-seven (31.1%) idiopathic megacolon/megarectum patients have had sigmoid volvulus in history or during current admission. In univariate analysis the significant correlation was revealed between sigmoid volvulus rate and age, rate of defecation without assistance, rate of integral parameter “defecation difficulties”, Wexner constipation scale rate (p < 0.05). There also was significant correlation between sigmoid volvulus rate and sigmoid length, sigmoid width, rectum width and rate of distal retention in gut transit test (p < 0.05). Due to multivariate analysis (multiple logistic regression) the best fit has the model, which sigmoid length, sigmoid width, and rectum width were included (Somers’ D — 0.867, KS statistic — 0.718, p < 0.0001). Sigmoid width (OR = 2.29; CI 1.38– 3.82) and rectum width (OR = 0.39; CI 0.22–0,72) were independent factors affected sigmoid volvulus rate. In the ROC analysis the area under the curve was 0.93 with a sensitivity of 82.4% and specificity of 89.2% in Youden’s point of 0.719. The nomogram for sigmoid colon volvulus risk prediction in idiopathic megacolon/megarectum patients was build up based this model.

CONCLUSION: idiopathic megacolon is associated with risk of sigmoid volvulus. The risk of sigmoid volvulus more than 90% estimated with the nomogram can be considered as a reason for elective surgery in idiopathic megacolon/ megarectum patients without sigmoid volvulus in anamnesis.

AIM: to evaluate the results of treatment of chronic anal fissure in combination with grade 3–4 hemorrhoids. PATIENTS AND METHODS: the prospective randomized study included 94 patients with chronic anal fissure in combination with grade 3–4 hemorrhoids, which had randomized in two groups. Forty-eight patients in the main group underwent controlled circular dilation (CCD) and 46 patients in the control group underwent lateral subcutaneous sphincterotomy (BPS). In both groups, patient underwent chronic anal fissure excision and surgical treatment of hemorrhoids.

RESULTS: the postoperative pain in group CCD was significantly lower than in the BPS group during all 7 days after surgery (p = 0.0085; p = 0.0001 — on the second and the 7th days, respectively). On the 7th day after surgery according to the profilometry the CCD method was more effective in liquidation internal sphincter hypertonia (p = 0.01), on the 45th — both methods were comparable (p = 0.27). On the 45th day after the surgery, values of rest intraanal pressure describing of the CCD and BPS methods had a comparable effect on internal anal sphincter function (p = 0.45), as well as the external sphincter (p > 0.05). On the 45th after surgery, the rate of postoperative wounds healing in the BPS group was 100%, in the CCD group — 85.4% (p = 0.02). Perineal hematoma was statistically more common in the BPS group (p = 0.014). In the frequency of the incidence anal incontinence clinical manifestations (AI) on the 45th day, CCD and BPS groups were comparable (p = 0.84).

CONCLUSION: CCD and BPS methods of internal anal sphincter hypertonia liquidation are comparable in the effectiveness, the overall incidence of postoperative complications, including temporary AI. The advantages of CCD method are a lesser pain syndrome and a low incidence of perineal hematoma in the near postoperative period.

AIM: to evaluate results of rectal resection in metastatic rectal cancer.

PATIENTS AND METHODS: a retrospective analysis of the results of treatment of 84 patients with symptomatic rectal cancer at stage IV, who underwent rectal resection in 2015-2020.

RESULTS: anastomotic leak developed in 5 (5.9%) patients. Postoperative mortality rate was 1 (1.2%). Ileostomy closure was performed in 66 patients (78.6%) 17.9 months after initial surgery. Progression of the disease was detected in 60 (71.4%) patients at following organs: liver (42.9%), peritoneum (19%), lungs (15.5%). Stabilization was significantly higher after systemic chemotherapy before and after perioperative chemotherapy comparing to patients who had preoperative radiation (p = 0.013). Proportional Cox regression model risks showed that the chances of death in patients with advanced rectal cancer after surgery was 4.1 times higher for peritoneal carcinomatosis, 2.9 times for liver metastases and 1.5 for multi organ metastasis.

CONCLUSION: low anterior resection with defunctioning ileostomy is associated with acceptable anastomotic leak rate (5.9%) and mortality (1.2%). Systemic chemotherapy in combination with target agents is preferable initial treatment in patients with metastatic rectal cancer.

THE AIM OF the STUDY was to study the results of surgical treatment of patients with trans- and extrasphincter fistulas of the rectum using laser coagulation, depending on the method of closure of the internal fistula opening.
PATIENTS AND METHODS: within the framework of scientific research conducted at the NMIC of Coloproctology named after A.N. During a 5-year period, 121 patients underwent surgical interventions using laser coagulation of the fistula passage in combination with 3 different options for closing the internal fistula opening.43 patients were included in the group of laser coagulation of the fistula course in combination with its ligation in the intersphincter space (LT+PSMP), 47 – in the group of laser coagulation of the fistula with plasty of the internal fistula opening with a mucomuscular flap (LT+SML), 31 - in the group of laser thermocoagulation of the fistula course with suturing of the internal fistula opening with separate seams (LT+UVC). The average age of patients is 42 (20-70) years. Men - 82, women -39. The average follow-up period was 19 (3-52) months. In the perioperative period (before surgery, 1 and 2 months after the intervention), patients underwent ultrasound monitoring to assess the healing process of fistulas and early detection of relapses of the disease. To assess the effect of operations on the functional state of the rectal occlusion apparatus before the intervention and 3 months after the operation, patients underwent sphincterometry.
RESULTS: in the LT+PSMP group, fistula healing was noted in 33/43 (76.7%) patients, in the LT+SML group - in 33/47 (70.2%) patients, in the LT+UVS group – in 17/31 (54.8%) patients (p=0.129). The only established factor that demonstrated a statistically significant effect on the frequency of positive results in the LT+PSMP group was the diameter of the internal fistula opening. Thus, with a fistula hole diameter of more than 3 mm, a positive result was achieved in 24 (54.5%) of 44 patients, and with a hole diameter of less than3.0 mm, the fistula course healed in 58 (75.3%) of 77 cases (p=0.025).The average length of a bed day (Iu) was 3.5. Complications during surgery and the immediate postoperative period were recorded in only 3 (2.5%) cases.
CONCLUSION: Over the five-year period of application, the laser coagulation method has proven itself as a sphincter-sparing intervention that can compete with traditional methods of treating rectal fistulas in a selected group of patients. Regardless of the method of closing the internal fistula opening, the technique has demonstrated a high level of safety. The best rates of healing were recorded when laser coagulation was combined with ligation of the fistula in the intersphincter space (76.7%), however, the search for the most reliable way to isolate the fistula from the lumen of the rectum should be continued.

AIM: to evaluate the predictive value of endorectal ultrasound (ERUS) and transperineal ultrasound (TPUS) in surgical treatment of post-traumatic anal incontinence (AI).

PATIENTS AND METHOD: it was a prospective two-center study. The study enrolled 35 women with obstetric perineal trauma followed by anal incontinence, who underwent delayed reconstruction of the sphincter-levator complex in the period 2019–2022 at the Lomonosov Moscow State University Research and Educational Center. Preoperatively ERUS and TPUS was conducted. All patients underwent overlap sphincteroplasty with subsecuent follow up. After surgery all patients were asked to fill online-forms with questions from Wexner Incontinence Score, FIQL and PISQ-12 score. Satistical evaluation with correlation analysis was performed.

RESULTS: the patients’ mean age was 33 years (SD = 5), the number of births varied from 1 to 3, and the mean time from symptom onset to specialist visit was 39 months (range: 0–240 months). Defects in the external anal sphincter (EAS) counted 47 to 116 degrees. The range of defect sizes in the internal anal sphincter (IAS) ranged from 76 to 177 degrees. The average follow-up period for patients was 7 months, with a maximum period of 4 years. The average degree of incontinence according to the Wexner Incontinence Score and quality of life according to the FIQL and PISQ-12 scale before the intervention were 13 (SD = 3.5), 1.9 (SD = 0.5) and 17 (SD = 6.8), respectively. After the treatment, the scores were 2,8(SD = 2,9), 3,6(SD = 0,6), 8,2(SD = 3,5). No correlation was found between ultrasound parameters and the results of the incontinence grade and quality of life scores.

CONCLUSION: the effectiveness of surgical treatment of postpartum anal incontinence did not depend on the size of the internal or external sphincter defect, as well as on other factors obtained by ultrasound diagnostics.

INTRODUCTION: the standard treatment for patients with locally advanced rectal cancer is the use of chemoradiotherapy (CRT) or intensive radiation therapy (RT) regimens with delayed surgery. Moreover, in 10–25% of cases, patients experience complete disappearance of the tumor during treatment. Current approaches to the management of cases with a good response involve organ-sparing treatment in patients with a complete clinical response (cCR), which means dynamic observation of the patient, or local excision of the scar at the site of a pre-existing tumor in cases of a near complete clinical response (nCR).

AIM: to analyze the results of treatment of patients with rectal cancer who had a good response to RT/CRT and who underwent transanal endoscopic microsurgery (TEM).

PATIENTS AND METHODS: from 2019 to 2023, 20 patients with rectal adenocarcinoma underwent TEM after RT/CRT. In all patients, the tumors were located in the distal rectum, which required either abdominoperineal resection or ultra low anterior rectal resection. The median interval between RT and surgery was 22 (12–78) weeks. In 5 (25.0%) patients included in the study, a cCR was registered for neoadjuvant treatment. In 15 cases, TEM was performed in patients with nCR. RESULTS: operation time was 117 minutes, the blood loss was 40 ml. A complicated postoperative period was observed in 4 (20.0%) patients, among whom the most serious complication was suture failure of the sutured intestinal defect — in 3 (15.0%) patients. Unfavorable prognosis factors were identified in 7 (35%) patients, while final TEM was performed in only 2 (28.6%) of them. In other clinical situations, active follow-up of patients was performed — local tumor recurrence was not detected in any case. With a median follow-up of 31.5 (3-54) months, signs of distant metastases were recorded in 2 (10.0%) cases. Local relapse at 12.3 months was detected in one case (5.0%). The cumulative three-year local recurrence rate was 6.2 ± 6.1%. Overall and disease-free three-year survival rates were 83.3 ± 10.8% and 80.4 ± 10.4%, respectively, and stoma-free survival was 92.9 ± 6.9%.

CONCLUSION: despite the fact that TEM in patients with rectal cancer after RT is an effective and safe method of treatment, its use in patients with cCR to confirm a complete response is inappropriate and carries an unnecessary risk of postoperative complications and possible functional dysfunction. The main indication for the use of TEM after RT/CRT is nCR, when local excision of the scar at the site of a pre-existing tumor allows not only to determine their pathological nature and treatment approach, but also for most patients it is a radical surgical intervention with a relatively low risk of local relapse.

AIM: evaluation the feasibility of usage ICG-angiography for the full-thickness rectal flap's formation at the surgery treatment of complex rectal fistulas.

PATIENTS AND METHODS: a prospective cohort study based on the study of intraoperative ICG-angiography and its video recordings in the surgery treatment of complex pararectal fistulas with bringing down a full-thickness rectal flap was performed. The study included 9 patients: 6(66.7%) - men and 3(33.3%) - women.

RESULTS: based on intraoperative ICG-angiography 3 types rectum's angioarchitectonics were identified: with 3, 4 and 5 distal branches of the rectal arteries, respectively. Subsequent detailed chronometry were showed that the time of onset of the arterial phase did not differ significantly, regardless of the formed flap's width. However, the following changes in the venous outflow were identified: at full-thickness flap's width of 1/3 of the rectal circumference, a slight lengthening of the venous outflow was observed, expressed in an increase of the average time for onset of the maximum fluorescence phase to 61.5 sec., compared with the intact rectum (58.2 sec.); at full-thickness flap's width of 1/4 of the rectal circumference - significant (p<0.05) extension of the average time for onset of the phase of maximum fluorescence to 77.6 sec., that is, in 1.26 times compared to patients with flap's width of 1/3 of the rectal circumference.

CONCLUSION: at the treatment of complex rectal fistulas with bringing down a full-thickness rectal flap, ICG-angiography makes it possible to visualize the vessels of the rectum at intraoperative condition, which contributes to the selection of the boundaries of the rectal area for the formation of a full-thickness flap, and also allows to assess of its blood supply.

AIM: to analyze recent literature data on colorectal cancer (CRC) and cases of CRC in pregnant.

PATIENTS AND METHODS: PubMed, MedLine, and Scopus medical databases 1998–2023 were analyzed. Epidemiology, diagnostic algorithms, patient management approach, prognostic criteria, as well as treatment outcomes were studied. The paper includes 2 clinical cases of pregnant patients with CRC with good outcomes.

CONCLUSION: the prognosis for colorectal cancer in pregnant women is poor and associated with late diagnostics and advanced disease. Treatment approach is extremely individual.

PATIENTS AND METHODS: in this pilot study using classical culture methods and analysis of 16S rDNA libraries sequenced on the Illumina MiSeq platform, we characterized the mucosa-associated microbiota of four diverticula in resected colon specimens of patients.

RESULTS: in all the samples the abundance of Enterobacteria and the shift towards the predominance of Bacteroides in the ratio of Prevotella-to-Bacteroides (P/B) was detected. In three samples, Firmicutes prevailed over Bacteroidetes. Also, in three samples the balance in the microbial landscape was strongly shifted towards one genus: Bacteroidetes, Parvimonas, Akkermansia, or Bifidobacterium.

CONCLUSION: microbiota inside inflamed diverticula revealed the specific shifts in the intestinal microbiome that may contribute to the progression of inflammation in the diverticulum up to its inflammatory destruction.

AIM: to work out an algorithm for diagnosis and tactics of treatment of complicated perianal abscess (CPA) in oncohematology.

PATIENTS AND METHODS: the cohort study (January 2021 — December 2022) included 78 patients with hematologic malignancies and infectious lesions of the perianal soft tissues. Complex perianal infection (CPI) was distinguished in the presence of supralevator abscess, pelvic phlegmon, destruction of the rectal wall above the level of the dentate line, and pelvic organs involvement. The correspondence of clinical, laboratory data and MRI results, as well as the results of surgical drainage, antibacterial therapy, and vacuum therapy were assessed.

RESULTS: CPI was detected in 7 (8.97%) patients with perianal infection. The neutropenia was detected in all patients (neutrophils < 500 × 109/l); no fever occurred in two patients. Clinical data were adjusted after MRI results in 6 (85.7%) cases. Pelviorectal abscesses were noted in 5 patients, in 2 — pelvic phlegmon was detected. In addition, 2 patients revealed perforation of the rectum above the dentate line, 1 — rectovaginal fistula. Due to sepsis, 4 (57.14%) patients were in the intensive care unit, the period in the intensive care unit was 32.5 (17–54) days. Abscess drainage was performed in all patients, in 3 cases — diverting sigmostomy. The wound repair phase was achieved in all patients. The time of reparation was 79 (37–142) days. Vacuum therapy was used in 2 cases with wound repair time of 53.5 days. Postoperatively, febrile fever with periods of normothermia for 1 month was revealed in all cases. Two patients died within 50 and 215 days from causes unrelated to perianal abscess.

CONCLUSION: pelvic MRI is a preferable diagnostic test to determine the volume of lesion in CPI in patients with hematological malignancies. CPI in patients with neutropenia is associated with a high incidence of sepsis. The main methods of infection control are abscess drainage and antibacterial therapy, which should be started before surgery and continued in the postoperative period until normothermia and regression of local signs of inflammation. Vacuum therapy is a safe and effective method in treatment of big postoperative wounds in patients with neutropenia.

AIM: to evaluate the efficacy of original method for pilonidal sinus (PS) treatment.

PATIENTS AND METHODS: a randomized study included 100 patients with PS in the chronic stage at the State Budgetary Healthcare Institution Research Institute-KKB No. 1, Department of Purulent Surgery from January 2021 to January 2023. In the main group, excision of the pilonidal sinus was performed with plastic closure of the wound defect of the sacrococcygeal region according to RU patent No. 2751821 from 07/19/21. The control group included patients with Bascom II (cleft lift). There were no significant differences in age (p = 0.355), BMI (p = 0.467), gender distribution (p = 1.0), recurrence rate (p = 0,204).

RESULTS: the operation time in the main group was longer (p < 0.001), which is associated with a surgical technique. Post-op stay (p = 0.027), the morbidity (p = 0,028) in the main group was significantly lower. The complications rate reduced to 4%, and the recurrence rate to 2%. It was possible to avoid re-operations.

CONCLUSION: the original method for wound closure after PS excision is simple and reliable.

Patient B., 45 years old admitted with signs of complicated diverticular disease. Complaints since 2021 of periodic pain in the lower abdomen, false urge to defecate. Repeated abdomen CT and contrast enema revealed a blindly ending duplication of the sigmoid colon up to 15 cm in length. The patient underwent laparoscopic resection of a duplicated portion of the sigmoid colon. The was favorable at the time of discharge.

Juvenile polyposis syndrome (JPS), a rare disease with an autosomal dominant mode of inheritance, which is characterized with the presence of multiple polyps in various parts of the gastrointestinal tract, mainly in the colon. The detection of adenomatous polyps in patients with JPS, in addition to juvenile ones, significantly complicates the differential diagnosis with familial adenomatous polyposis, in which it is necessary to perform a radical surgery — proctocolectomy. Only in 40-60% of cases, pathogenic variants of the SMAD4 and BMPR1A genes can be identified, each of which is characterized with its own clinical manifestations. Treatment options for patients with JPS include endoscopic and surgical; however, the decision-making algorithm, as well as the timing of postoperative follow-up, are not evaluated in Russian clinical guidelines. The rare occurrence of this syndrome, difficulties in endoscopic diagnosis and morphological verification, as well as limitations in determining the molecular genetics cause of the disease demonstrate the need for further research.

Inflammatory bowel diseases (IBD) include Crohn’s disease and ulcerative colitis. IBDs are chronic diseases with a trajectory of remission and relapse. Drug therapy for IBD is not effective enough. There is a need for adjuvant therapy for IBD. The purpose of this review was to present the role of exercise and its impact on IBD. In this regard, a search is underway for additional tools to increase the frequency of achieving and maintaining remission. There is recent evidence that exercise induces a cascade of anti-inflammatory cytokines, specifically triggered by an exponential increase in muscle interleukin 6, and with regular exercise during remission may reduce basal levels of circulating inflammatory markers and potentially reduce chronic inflammation in IBD. Doctor’s recommendations for physical activity during remission can be effective as an additional component of anti-relapse treatment.

Parathyroid hormone-related protein (PTHrP) is associated with various cancer types. This is the first review in the Russian, devoted to this topic, and it is aimed to contribute to the current knowledge about colorectal cancer, by means of summarizing all known information on the topic and identifying future directions for advanced research including on the role of parathyroid hormone-related protein in colorectal oncogenesis, signal channels that participate in mitogenic action of the protein on cancer cells, its effect on tumor angiogenesis. The review includes results of modern research involvement of PTHrP in the formation of chemoresistance of colorectal cancer cells, as well as its influence on the modulation of the epithelial-mesenchymal transition program and other events, associated with tumor invasion. The review presents information proving that PTHrP is related to colorectal cancer cells becoming of an aggressive phenotype; the work also describes molecular mechanisms involved in these processes. There is a growing interest to use this rather unique protein in therapies, which determines active development of pharmaceutical substances based on analogues of this protein. The final goal is to advance the development of effective therapeutic strategies, which could improve the treatment results of colorectal cancer in patients.

AIM: to identify predictors of steroid resistance among patients with severe ulcerative colitis (UC).

PATIENTS AND METHODS: the systematic review and meta-analysis were done, 18 observational case-control studies and 2545 patients with severe UC were included.

RESULTS: the rate of patients with effective steroid therapy was 69.5%, and steroid resistance occurred in 30.5%. Pancolitis (OR = 1.5; 95% CI: 1.1–2) and endoscopic picture on the UCEIS ≥ 7 points (OR = 4.5; 95% CI: 3.2–6.5) were predictors of steroid resistance. The levels of albumin and C-reactive protein before the start and on the 3rd day of steroid treatment were also significantly corresponded with adverse outcome of the treatment (p < 0.00001). CONCLUSION: predictors of an adverse outcome are steroid resistance with pancolitis and endoscopic picture on the UCEIS scale ≥ 7 points. Hypoalbuminemia and high level of C-reactive protein were associated with the steroid resistance as well.

INTRODUCTION: there is no consensus on the need for closure of rectal wounds after transanal endomicrosurgery (TEM). The results of studies on the treatment of patients using open and closed wound management are presented in this meta-analysis.

AIM: to compare 2 methods of rectal wound management in patients after TEM.

MATERIALS AND METHODS: a systematic review and meta-analysis was performed in accordance with PRISMA guidelines.

RESULTS: six studies were selected for the period from 2002 to 2021. The meta-analysis included 808 patients: in 383 (47%) patients the rectal wound was managed openly, in 425 (53%) patients it was sutured. The incidence of postoperative bleeding was 6% (23/383) in the open wound management group vs. 3.3% (14/425) (OR 0.47; 95%CI 0.18–1.26). The infection rate was 3.3% (14/425) in the suturing group vs. 1.8% (7/383) in the open wound management group (OR 1.66; 95%CI 0.69 — 4.00). Mean operating time in the group with suturing of the rectal wound is 7–8 minutes longer; 95%CI -2.21-17.6. Mean postoperative hospital stay for patients in the rectal wound suturing group was increased by 12 hours.

CONCLUSION: wound suturing after TEM does not lead to significant reduction of postoperative bleeding and infection.