BACKGROUND. The main reason of impaired quality of life in patients undergoing low anterior resection for rectal cancer is Low Anterior Resection Syndrome (LARS). A symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer has been developed in 2012 and validated in many European countries. The aim of our study was to adapt the LARS score to the Russian language, and assess its psychometric properties. METHODS. The LARS questionnaire was translated into Russian using a standard procedure of double-back translation according to WHO and EORTC recommendations. At the first stage the LARS questionnaire and the EORTC QLQ-C30 questionnaire were completed at the same time by 80 patients who underwent anterior/low anterior resection at the State Scientific Center of Coloproctology, Moscow, Russia. At the next stage 40 patients were interviewed with the LARS questionnaire by phone. RESULTS. Fifty-three patients (44,2%) had no LARS, 25 (20,8%) had minor LARS, and 42 (35%) had major LARS. The LARS score showed significant correlations with all the assumptive domains of EORTC QLQ-C30 questionnaire (р<0,05). According to the results of univariate analysis preoperative chemo-radiotherapy (р=0,009), splenic flexure mobilization (р=0,0003) and total mesorectal excision (р=0,02) increased LARS score. However, only splenic flexure mobilization in the binomial logistic regression model was the only independent factor, leading to major LARS (р=0,002). CONCLUSIONS. The Russian version of the LARS score shows acceptable psychometric properties and can be considered as a valuable and specific instrument to assess bowelfunction in rectal cancer patients, bothfor research purposes and in clinical practice.

AIM. It was to evaluation the effect of using of transanal reinforcement of low colorectal anastomosis to the frequency of anastomotic leakage. MATERIALS AND METHODS. The study included six patients who underwent a low anterior resection for rectal cancer and the transanal reinforcement anastomosis. Preventive stomas not formed. RESULTS. The study contains an analysis of the immediate results of patients treatment. The leakage of the anastomosis was developed in 3 of 6 patents. This required break down of the anastomosis in one and the formation of diverting stoma in two patients. CONCLUSION. The first experience of the transanal reinforcement for low colorectal anastomosis is unsuccessful because of leakage appeared in every second patient. More careful selection of patients for this method is required.

PURPOSE. To evaluate the results of surgical treatment of hemorrhoids in combination with other pathologies of the rectum and anal canal. MATERIALS AND METHODS. 331 patients are operated in clinic concerning non-neoplastic surgical pathology of the anal channel (AC) and the rectum (R) from 2012 to 2015. The probed group (PG) was 159 (48,0±2,7%) patients who underwent combined surgical treatment of hemorrhoids and other pathology AC and R. Control group (CG) was 172 (52,0±2,7%) patients who underwent hemorrhoidectomy. RESULTS. The average duration of surgery in PG was 28±5 min, in CG - 19±3 minutes (p>0.05). The amounts of long-term postoperative complications in the PG was 4,4±1,6/, in the CG - 2,3±1,1% (p> 0,05).The average duration of hospitalization in the PG was 5,1±1,0 days, in СG - 3,2±1,0 days (p> 0,05), the duration of rehabilitation in the PG was 20,3±3,2 days, in CG -15,1±2,0 days (p>0,05). CONCLUSION. Existence of the pathology of AC and R in combination with hemorrhoids is the indication to the combined surgical treatment. The increation in the duration ofsurgery, postoperative complications, duration of hospitalization and rehabilitation in the PG compared with the CG are not statistically significant. Simultaneous surgical treatment of hemorrhoids and other pathologies AC and R relieves the patient from having to perform repeated surgery and its possible complications.

Transanal Doppler-controlled, deartetialization with mucopexy - a new direction in minimally invasive treatment Haemorrhoidal disease grade II and IV. The number of patients showing relief of Haemorrhoidal symptoms at 52-month follow-up was high. Bleeding was resolved in 92.9% of the patients. The recurrence of prolapse at 52 months was low, with no re-prolapse being recorded in 89,6% of the patients. Doppler-guided Haemorrhoidal artery ligation with transanal rectal mucopexy, not only has several perioperative advantages - minimally invasive surgery, low major complications - but also offers prolonged relief for all hemorrhoidal symptoms. Technology is an effective form of treatment for hemorrhoidal disease.

Our aim was to develop a system of parameters that could, enable differentiation between idiopathic and Crohn’s disease (CD) associated fistula without intestinal lesions. 28 healthy individuals, 9 patients with idiopathic fistula and 12 patients with Crohn’s fistula participated in our study. We evaluated different peripheral blood T-cell populations by means of flow cytometry. CD62L^lowCD45RA+ effector T-cells were increased in the idiopathic fistula cases (p<0,05) and decreased in Crohn’s fistula cases (p<0,01) compared with the control 9roup. On the contrary, naïve CD62L^highCD45RA+ T-cells were higher in the idiopathic fistula group and lower in Crohn’s fistula cases (p<0,01). No difference between CD4+CD69+, CD4+CD161^high and CD4+CD161^low Т-cell levels was shown between healthy controls and Crohn’s fistula cases, however, CD4+CD161^high and CD4+CD161^low T-cell levels were lower (p< 0,01 and p < 0,05, respectively) and CD4+CD69+ T-cell levels were higher (p<0,01) in the group of idiopathic fistulas compared with the control. Moreover, Crohn’s fistulas showed the decrease of CD8+CD25+ T-cell level (p<0,01) and the increase of CD8+CD161^high T-cell absolute count (p<0,05) compared with idiopathic0 fistula cases. Thus peripheral T-cell immune phenotypin9 seems to be promising for early identification of CD that manifests as an isolated anorectalfistula.

AIM to improve results of treatment of patients pylonidal disease. PATIENTS AND METHODS. Thirty two patients with pylonidal disease had a wide excision with postoperative wounds left open. The patients were allocated into 2 groups: in the main group a local negative pressure was used for management of postoperative wounds, while in the control group ointment dressings was used only. Groups were well matched by age, stage of the process and the area of the surgical wound. RESULTS. The use of local negative pressure in the topical treatment of open surgical wounds allowed to reach complete recovery in the main group on 32 ± 5 POD, while in the control group it lasted 41 ± 7 days. No recurrences of the disease in both group were detected. CONCLUSION. Application of the negative pressure in the local topical treatment of open surgical wounds after excision of pylonidal disease accelerates wound healing, helps to avoid the development of suppuration and provide an earlier recovery.

AIM. Ligation of intersphinctericfistllа tract (LIFT) is a new sphincter-preserving technique avoiding development of anal incontinence. The aim of the study is evaluation of effectiveness of this procedure. METHOD. From Jan 2013 to Dec 2015 40 patients with anal fistulae, exciting more than 30% of anal sphincter was included in the study. Male: 28 (70%), Female: 12 (30%). 29 (72,5%) cases were middle transsphincteric, 16 (22,5%) - deep transsphincteric and 2 (5%) was suprasphincteric. RESULTS. The median follow up was 16 months ((3-36) months). The healing rate was (72,5%). Recurrents developed in 5 (17,3%) patients with middle transsphincteric fistulae, 5 (55,6%) - with deep transsphincteric fistulae, and 1 (50%) with suprasphincteric fistulae. 4 patients developed an intersphincteric abscess. After excision of this fistulae healing occurred in all four cases. A second operation did not affect the function of anal continence. At follow-up there was no change in continence evaluated by Wexner score and anorectal manometry. CONCLUSION. LIFT has a high success rate in middle transsphinteric anal fistulae. Recurrence is related to deep portion fistulae or suprasphinteric fistula tract.

PURPOSE. To determinate manometric parameters for different degrees of anal sphincter insufficiency (ASI) by the non-perfusion water sphincterometry with measurement device WPM Solar (MMS, The Netherlands). METHODS. The study included 228 patients with complaints of incontinence of various components of the intestinal contents. Among them were 94 (41,2%>) men, mean age 47,3±16,8 year, 134 (58,8%) women, mean age 49,1±15,9 year. The patients were divided according to the clinical classification of anal sphincter insufficiency (ASI) developed by Russian State Research Center of Coloproctology. Grade I was present in 112 (49,1%) patients complaining of gas incontinence. Grade II - in 80 (35,1%) patients with gas and liquid incontinence. Grade III - in 36 (15,8%) patients with all components incontinence. The Cleveland Clinic (Wexner) fecal incontinence score applied to all patients as the subjective assessment of the severity ASI. For an objective assessment of the anal sphincter insufficiency used sphincterometry. RESULT. This study has allowed to build a reliable reference intervals manometric and score (Wexner scale) parametrs for all grades ASI, separately for men and women First grade ASI (male/female): mean resting pressure - 32,8-42,0 / 36,3-40,0 mm Hg, max. squeeze pressure -115,0-120,0 / 97,4-109,0 mm Hg, mean squeeze pressure - 89,5-105,0 / 68,8-87,0 mm Hg, squeeze gradient - >79,5 / 73,6 mm Hg, score -<4,2 / <6,3. Second grade ASI (male/female): mean resting pressure - 25,3-32,7 / 26,9-36,2 mm Hg, max. squeeze pressure - 74,9-114,9 / 61,9-97,3 mm Hg, mean squeeze pressure - 53,0-89,4 / 46,0-68,7 mm Hg, squeeze gradient 49,9-77,0 / 35,9-58,0 mm Hg, score - 4,3-10,1 / 6,4-10,7. Third grade ASI (male/female): mean resting pressure - <25,2 / <26,8 mm Hg, max. squeeze pressure - <74,8 / <61,8 mm Hg, mean squeeze pressure - <52,9 / 45,9 mm Hg, squeeze gradient < 49,8 / 35,8 mm Hg, score - >10,2 / > 10,8.