AIM: to estimate early and late outcomes of multivisceral surgeries (MVS) with pancreaticoduodenalectomy (PD) for colorectal cancer.
PATIENTS AND METHODS: the main group included 42 patients who underwent MVS with PD for colorectal cancer from January 2011 to April 2024. The control group included 46 patients with colorectal cancer who underwent colorectal resection with resection of the duodenum and/or head of the pancreas, i.e. MVS without PD.
RESULTS: controls were more likely to have ECOG status 2-3 (44/46 (95.7%) vs. 33/42 (78.6%), p = 0.022), were more likely to have tumor stenosis of the colon/duodenum (31/46 (67.4%) vs. 16/42 (38.1%), p = 0.006), were less likely to have ischemic heart disease (6/46 (13.0%) vs. 14/42 (33.3%), p = 0.023), and were less likely to have pancreatic invasion (5/46 (10.9%) vs. 20/42 (47.6%), p = 0.001). Control patients (MVS without PD) received adjuvant chemotherapy (ACT) significantly more often (34/46 (73.9%) vs. 21/42 (50.0%), p = 0.021). The incidence of postoperative complications by Clavien-Dindo grade 3 and higher and mortality in both groups were comparable (13/42 (31%) vs. 11/46 (23.9%), p = 0.2) and (3/42 (7.1%) vs. 3/46 (6.5%), p = 1,0), respectively. The risk of locoregional recurrence in the control group was significantly higher (18/43 (41.9%) vs. 4/33 (12.1%), p = 0.005). Locoregional recurrence was an independent negative factor of prognosis in the control group (HR 3.96; 95% CI (1.66–9.44), p = 0.002). Overall five-year survival in the main group (MVS with PD) was 42.1%, (95% CI (17.2–65.4), and in the control one (MVS without PD) — 26.4% (95% CI (11.8–43.6). The median overall survival in the main group was 44 months (95% CI: 26 — ∞), in the control one — 13 (95% CI: 10–31). The differences in overall survival rates were significant (p = 0.005). The risk of mortality in the late period in the control group was significantly higher (HR 2.49; 95% CI (1.27–4.91), p = 0.008). In univariate analysis, superior mesenteric vein invasion had a significant effect on overall survival (HR 21.84; 95% CI (1.52–313.78), p = 0.02.) The only independent factor of negative prognosis is metastases in 4 or more regional lymph nodes (N2 of the primary tumor). Multivariate analysis revealed that independent negative factors for overall survival rates were locoregional recurrence (HR 4.65; 95% CI (2.1–10.44), p < 0.001), invasion of the superior mesenteric vein (HR 41.77; 95% CI 4.25–409.73, p = 0.001), and positive factors were the fact of performing MVS with PD (HR 0.29; 95% CI (0.12–0.7), p = 0.005) and adjuvant chemotherapy (HR 0.34; 95% CI 0.14–0.8, p = 0.013).
CONCLUSION: multivisceral resection with pancreaticoduodenectomy for local advanced colorectal cancer with duodenal and / or pancreatic head invasion is the operation of choice in the presence of appropriate conditions.

AIM: to identify risk factors for perforation during colorectal ESD for early colon cancer.
PATIENTS AND METHODS: the study included 61 patients with early colon cancer who underwent ESD in 2018–2023. Perforation was defined as a deep muscular layer defect down to serosa with its preservation without connection with free peritoneal cavity. Clinical risk factors for perforation during ESD, including age, gender, tumor morphology, tumor size, tumor location, procedure time, were analyzed.
RESULTS: the mean ESD specimen size was 20.0 (1.50–2.80) mm. The overall en bloc resection rate was 81.7%. Perforations occurred during ESD in 6 of 61 patients (9.9%). All perforations were successfully treated with endoscopic closure using hemoclips and nonsurgical management. No emergency surgery occurred. On univariate analysis, tumor size ≥ 2.0 cm (p = 0.04), localization in the right colon (p = 0.04), 2B-high type\JNET classification (p = 0.0004), negative lifting (p = 0.04) were the factors most significantly associated with perforation.
CONCLUSION: tumor size ≥ 2.0 cm, tumor site in the right colon, 2B-high type (JNET), negative lifting are risk factors for perforation during ESD in early colon cancer.

AIM: to assess features of pathomorphological changes in the intestinal wall in patients who had new coronavirus infection SARS-CoV-2.
PATIENTS AND METHODS: the study included 8 patients who underwent surgery for complications of pseudomembranous colitis and had previously COVID-19. Six patients underwent colectomy, and two underwent subtotal colectomy with end ileostomy. Histology of the removed specimens was standard.
RESULTS: in all specimens, in addition to the changes peculiar for pseudomembranous colitis, vascular lesions of the bowel wall were detected as vasculitis of small arteries and vessels of the microcirculatory network, phlebitis and thrombosis of venous vessels like in COVID-19. These pathological changes in blood vessels may reveal the intramural perfusion disorders of blood circulation, leading subsequently to ischemic changes.
CONCLUSION: when treating patients with pseudomembranous colitis and postcovid syndrome, it is necessary to take into account the mutually aggravating effect of both diseases, when assessing risks, determining indications for surgery and conservative measures.

AIM: the aim of this article was to demonstrate the possibilities of using TEM for large (more than 5.0 cm) and giant (more than 8.0 cm) rectal adenomas.
PATIENTS AND METHODS: more than 1000 transanal endoscopic microsurgery procedures were performed in 2011- 2023. Three groups were distinguished according to the tumor size: Group I — tumors less than 5.0 cm; Group II — tumors 5.0–8.0 cm (large); Group III — tumors more than 8.0 cm (giant).
RESULTS: the final analysis included 600 patients. Group I with sizes less than 5.0 cm included 465 (77.5%) patients. Group II — large adenomas 5.0–8.0 cm included 120 (20%) patients. The group of giant tumors, larger than 8.0 cm, included 15 (2.5%) patients. In group I (less than 5.0 cm), the R0 rate was 92%, then in group II of large adenomas (5.0–8.0 cm) it was only 75%, and in the case of removal of giant adenomas (more than 8.0 cm) — 46% (p < 0.001). In multivariate analysis, independent risk factors for R1 resection were giant tumor size over 8.0 cm (OR 5.5; 95% CI: 1.4–20.3; p = 0.006) and tumor site close to the dentate line (OR 2.6; CI: 1.17–5.89; p = 0.0005).
CONCLUSION: giant size (over 8.0 cm) and adenoma site in the low rectum close to the dentate line are independent risk factors for non-radical resection during transanal endomicrosurgery.

AIM: to develop methods of conservative treatment of proctological patients based on pelvic floor muscles (PFM) neurophysiology.
PATIENTS AND METHODS: thirty-seven patients with pudendal neuropathy manifested by anal incontinence (AI) and/or obstructive defecation and/or neurogenic pelvic pain (and their combination) included in the prospective cohort study. There were 5 patients (13.5%) with proctogenic constipation as the main complaint, 12 (32.4%) with AI, 14 (37.9%) with neurogenic pelvic pain; 6 (16.2%) with combined disorders. There were 22 (59.5%) women, 15 (40.5%) men, aged 47.1 ± 15.7 years. All patients underwent a comprehensive checkup by a proctologist, colonoscopy, gynecologist/urologist. The neurophysiological tests were performed according to the developed algorithm, including stimulation EMG (PNMTL) with the late phenomena and bulbocavernosus reflex (BCR), as well as interference EMG to identify dysfunction of the PFM. Patients with obstructive defecation additionally underwent high-resolution anorectal manometry, defecography and evacuation test. Patients with AI underwent complex sphincterometry. All patients underwent conservative treatment, which depended on the obtained diagnostic data.
RESULTS: according to PNTML, pudendal neuropathy were diagnosed only by an increase in the latency of the M-response in 21 patients (56.8%). In this case, all had a unilateral change (up to 3.6 ± 1.1 ms on the right in 6/21 (28.6%) and up to 3.2 ± 0.6 ms on the left in 15/21 (71.4%). Based on the increase in the latency of late phenomena, pudendal neuropathy was detected in another 10 (27%) patients — up to 52.6 ± 9.1 ms on the right and up to 51.4 ± 7.1 ms on the left; based on the increase in the latency of the BCR in 6 (16.2%) people — up to 52.3 ± 5.4 ms on the right and up to 51.9 ± 7.3 ms on the left. All patients underwent interference EMG. EMG-signs of PFM dysfunction during the push-test were detected in 24 (64.9%) patients, which coincided with the data of high-resolution anorectal manometry (HRAM) — among them were not only patients with predominant complaints of proctogenic disorders, but also from other groups: 10 (41.6%) with obstructive defecation, 7 (29.2%) with neurogenic pelvic pain, 3 (12.5%) with AI, 4 (16.7%) — with mixed manifestations. Signs of AI according to sphincterometry data were detected in 20/22 women (resting pressure 34.4 ± 4.0 mmHg, squeezing pressure 99.4 ± 22.0 mmHg) and in 11/15 men (37.7 ± 2.4 mmHg and 122.0 ± 39.0 mmHg). The clinical output of the algorithm we created was the development of a biofeedback (BFB) technique on a myographic complex of diagnostic profile with high-intensity magnetic stimulation (HIMS).
CONCLUSION: patients with pudendal neuropathy may have concomitant dysfunctions in the form of AI, obstructive defecation and neurogenic pelvic pain. Given the dominant nature of the pain syndrome, obstructive defecation and anal incontinence are undiagnosed conditions and, in some cases, have a latent manifestation, which requires targeted questioning of patients and additional examination, including PNTML, interference EMG, HRAM, complex sphincterometry, defecography. The use of biofeedback on a diagnostic myographic complex in combination with HIMS allows for adequate training of patients in the synergistic work of the PFM and the abdominal muscles for proper defecation/urination and faeces/urine retention.

A clinical case of treatment of a 24-year-old patient D. with perforations of the colon and widespread fecal peritonitis after laparoscopic shaving of extragenital foci of the sigmoid and rectum is described. This clinical case demonstrates the possibility of using the laparoscopic method for colon perforation and advanced peritonitis. Reducing the volume of surgical aggression it contributed to the early rehabilitation of the patient and was not accompanied by complications. The use of programmatic sanitation laparoscopy in abdominal sepsis made it possible to avoid the formation of laparostoma, which later allowed reconstructive surgery to be performed using the laparoscopic method.

AIM: to develop a unified algorithm of bowel cleansing for the colonoscopy, to distinguish the main criteria of qualitative colonoscopy and the rules of protocol in patients after colorectal surgery.
PATIENTS AND METHODS: we analyzed the available literature data and our own experience of endoscopic examination of patients with operated colon.
RESULTS: a unified algorithm of patient preparation for colonoscopy, examination rules and criteria for execution of the examination protocol for patients with different types of surgical interventions on the colon were developed.
CONCLUSION: it is necessary to raise awareness of surgeons and oncologists about the rules and peculiarities of preparation for colonoscopy in patients after colorectal surgery. It is necessary to use a unified methodology of endoscopic examination of such patients, and to use a single technique of endoscopic examination.

Two girls showed dehiscence of postoperative scar and recto-perineal fistula after surgery for anal atresia. They underwent surgery which included excision of evaginated rectum and reconstruction of external anal sphincter without diverting stoma. No intraoperative or postoperative morbidity developed. Both patients showed a progressive restoration of sphincter tone and a decrease in anal incontinence. Proposed method reduces the operative injury and reduces the risk of inflammatory complications.

AIM: to compare the effectiveness of different techniques for parastomal hernia prevention.
MATERIALS AND METHODS: a systematic review and meta-analysis were performed in accordance with the PRISMA recommendations for the entire period up to 09/08/2023. The search for papers is carried out in PubMed with keywords “extraperitoneal”, “transperitoneal”, “intraperitoneal”, “rectal cancer”, “abdominoperineal resection”, “parastomal hernia”, “colostomy”, “stoma”, “end colostomy”, “prophylactic mesh”, “mesh”. As a result of the literature selection, 28 studies were included in the meta-analysis — 15 studies for end colostomy with and without an implant; 5 studies comparing intra-abdominal and extraperitoneal end colostomy; 8 studies comparing stoma channels through the rectus abdominis shield (transrectal stoma) and lateral stoma.
RESULTS: the incidence of parastomal hernias is significantly lower for extraperitoneal stoma (p = 0.05) than intraabdominal one (OR = 3.40, CI 1.01–11.44) without significant increase in postoperative morbidity rate (OR = 1.04, CI 0.53–2.02, p = 0.92, OR = 2.22, CI 0.67–7.30, p = 0.19). Mesh significantly decreases the incidence of parastomal hernias (OR = 1.87, CI 1.16–3.01, p < 0.0001) without a consistent increase in postoperative morbidity rate (OR = 0.93, CI 0.47–1.82, p = 0.82). No significant differences were obtained between lateral and transrectal colostomies in the incidence of parastomal hernia (OR = 1.14, CI 0.52–2.52, p = 0.74).
CONCLUSION: the extraperitoneal colostomy and meshes reduce the risk of parastomal hernia.

AIM: to analyze publications and assess the current state of the issue on the comparative efficacy and survival of different classes and different lines of biological therapy for inflammatory bowel diseases (IBD)
MATERIALS AND METHODS: the search for publications was done in the PUBMED, MEDLINE, EMBASE databases and Cochrane Library from 2013 to 2024 using key words and phrases “Inflammatory bowel disease”, “ulcerative colitis”, “Crohn’s disease”, “biologics survival/persistence”, “comparative efficacy of biologics in different therapy lines”, “biologics”, “immunogenicity”. 
RESULTS: loss of response over time is observed for all biologic agents. The choice of the first biologic agent may affect the efficacy of subsequent lines of therapy. TNF inhibitors are most often prescribed in the first line of therapy, but their survival in IBD is lower compared to biologic agents of other classes: half of the patients loses response after 1–2 years. Switching within one class of biologic agents (TNF inhibitors) reduces the efficacy of the second line of therapy. The survival of INF and ADA is comparable in CD, but in UC, the survival of INF is higher than that of ADA and GOL. Data on the efficacy and survival of VEDO in the 1st and 2nd lines of therapy are contradictory. Most studies assessing the survival and efficacy of biologic agents do not exceed one year, that is insufficient to predict the long-term outcome. There is data on high long-term efficacy and survival of UST without significant loss of response for 4–5 years in bio naive IBD patients and in bio failures. UST has a higher survival rate than VEDO in the second line of therapy in case of loss of response to INF. In case of loss of response to biologics, it is advisable to evaluate the level of antibodies and drug concentration in the blood.
CONCLUSION: studies on the survival and long-term efficacy of biologic therapy are very limited and contradictory. More direct comparative studies of different classes of biologics in the first and subsequent lines of therapy are needed. In real practice, it is necessary to consider the existing data on the survival of biologics when choosing therapy.

AIM: to analyze literature on perineal military injuries.
PATIENTS AND METHODS: a search of sources was carried out using eLIBRARY.RU and the PubMed.gov using the keywords: “perineal wounds”, “rectal wounds”, “perineal trauma”, “perineum injury”, “rectal injuries”, “perineum trauma” for the last 10 years.
RESULTS: recently, the main method for military injuries of the perineum with damage to the extraperitoneal part of the rectum is the 4D method: diverting stoma, elimination of the rectal defect, presacral drainage and distal lavage of the rectum, as well as primary surgical treatment of the wound with subsequent sanitation. For such injuries received in peacetime, the authors are inclined to a more differentiated approach, which usually differs from the 4D concept. It is worth noting that the methods and results of treating perineal wounds received in peacetime cannot be unambiguously projected onto the treating of military injuries. This is due to the morphological features of perineal wounds received in military actions.
CONCLUSION: perineal injuries occur in approximately 5.4% of cases of total military actions. The most pressing problem is combined trauma of the extraperitoneal part of the rectum. The generally accepted conception was developed during the Vietnam War. Since then, the approach has not changed crucially, and most studies are, as a rule, descriptive in nature and do not provide clear recommendations for treatment.

AIM: to assess the most promising areas in the field of studying the microbiome of the colon in patients with complicated forms of diverticular disease, which can be used in clinical practice.
MATERIALS AND METHODS: a systematic literature search of electronic databases (PubMed, EMBASE, Cochrane, Research gate, Scopus) for the past 20 years was done. Initially, 14 meta-analyses, 342 reviews, 116 clinical studies, and 27 experimental studies were found. After screening and evaluating the summary, 12 meta-analyses, 24 reviews, 22 clinical studies, and 5 experimental studies were selected. This article has been prepared in accordance with PRISMA standards.
RESULTS: there is a decrease in the representation of Bacteroidetes, Fusobacterium, Clostridium clusters IV and IX, Lactobacillaceae, and other microorganisms with anti-inflammatory properties and the ability to synthesize shortchain fatty acids. In addition, in all types of diverticular disease, there is an increase in the population of Roseburia hominis and Akkermansia muciniphila. With a complicated course of diverticular disease, there is an increase in the number of representatives of the Proteobacteria family, and with symptomatically uncomplicated diverticular disease — Firmicutes. According to studies, there is a change in the concentration of specific urinary and fecal biomarkers in the blood — hippurate, kininurenine and short-chain fatty acids, therefore, the assessment of the metabolome may be considered a justified goal in determining and predicting changes in the microbiome in these patients with diverticular disease.
CONCLUSION: there is evidence that an increase in the severity of inflammation in diverticular disease may be associated with an increase in the generic diversity of the fecal microbiota. Other bacterial metabolites can act as diagnostic and prognostic markers of the severity of the disease.

Acute bowel obstruction is the most common complication of left colon cancer, with the age of patients with this pathology in most cases being over 75 years. The optimal surgical approach in this group of patients remains debatable. A search of scientific studies on the treatment of left-sided malignant obstruction in elderly and octogenarian patients was done in the Elibrary.ru, PubMed, and Medline databases from 2008 to 2023. To date, there is no irrefutable evidence to support whether emergency surgery or colonic stent placement is optimal treatment in terms of the morbidity, mortality and late oncological outcomes. A current solution to the problem can be temporary decompression of the bowel. The literature demonstrates advantages of diverting colostomy at the first stage in decrease in perioperative mortality, an improvement in the quality of life due to a decreased morbidity and mortality rate, good oncological.