AIM: to present the results of molecular genetic testing in patients with suspected juvenile polyposis syndrome (JPS).

PATIENTS AND METHODS: molecular genetic testing was performed on 30 patients from 28 families (one family had three affected relatives) who were followed from 2012 to 2024. DNA was isolated from patients’ peripheral blood leukocytes. The initial step involved Sanger sequencing of the SMAD4 (NM_005359.6) and BMPR1A (NM_004329.3) genes, followed by screening for large rearrangements using MLPA (Multiplex Ligation-dependent Probe Amplification). Finally, patient DNA was analyzed by whole-exome sequencing (WES), with confirmation of identified variants by Sanger sequencing.

RESULTS: pathogenic and likely pathogenic variants in the BMPR1A and SMAD4 genes were identified in 18 out of 28 families (64.3%). In the BMPR1A gene, 11 out of 18 (61.1%) germline variants were found, including three large deletions. In the SMAD4 gene, 7 out of 18 (38.9%) germline variants were detected, including one large deletion and one large duplication. Thus, 5 out of 18 (27.8%) germline variants in these genes were large rearrangements. In five families, previously unreported germline variants were identified (three in BMPR1A and two in SMAD4), all classified as likely pathogenic.

CONCLUSION: all patients with suspected juvenile polyposis syndrome should be tested for SMAD4 and BMPR1A mutations using Sanger sequencing and MLPA. If the result is negative, high-throughput sequencing should be employed. For patients with 20 or more adenomatous colorectal neoplasms but no pathogenic/likely pathogenic variants in the APC and MUTYH genes, it is advisable to proceed directly to whole-exome sequencing.

AIM: to evaluate the oncological and surgical results of the treatment in patients with recurrent squamous cell anal carcinoma (SCAC) after CRT and to identify prognostic factors of overall survival (OS).

PATIENTS AND METHODS: patients who underwent abdominoperineal resection (APR) between January 2013 to December 2024 for persistent or recurrent squamous cell carcinoma of the anal canal after CRT were retrospectively analysed in a single-centre study. The early and long-term outcomes, recurrence and incomplete response to CRT were compared. The primary endpoint was overall survival (OS). Additionally, the disease-free survival (DFS), the R0 resection rate, post-op complications, risk factors, second recurrence after APR were evaluated.

RESULTS: sixty-one patients underwent APR, of which 34 (55.7%) had a recurrence and 27 (44.3%) had an incomplete response to CRT. The median follow-up was 35.9 months (95% CI: 25.3–46.6). The overall 3-year survival rate was 66.5% (95% CI 54.0–81.9%). The 3-year OS was 74.0% for relapses (95% CI 59.3–93.0%) and 56.4% for incomplete response to CRT (95% CI 37.9–84.0%). The differences in OS were unreliable (HR 1.8; 95% CI: 0.7–4.6; p = 0.2). The 3-year DFS was 55.4% (95% CI 43.2–71.1%). Three-year DFS was 63.1% (95%CI 47.4–83.7%) for relapses and 46.1% (95% CI 29.2–72.5%) for incomplete response to CRT. Differences in DFS were unreliable (HR 1.70; 95% CI: 0.7–4,5%; p = 0.18). Ten (16.1%) patients developed distant metastases after surgery. Sixteen (47.1%) patients developed local recurrence after APR, 2 (12.5%) of them underwent salvage re-operation and another two of them (12.5%) underwent repeated radiation therapy. Seven (43.7%) out of 16 patients received palliative chemotherapy. The remaining 5/16 (31.3%) patients received symptomatic treatment. The median age of patients with recurrent relapse was 23.9 (95% CI 23.7–24.1) months. R0 resection was performed in 55 (90.30%) patients. OS was significantly reduced by incomplete response of the primary tumor to CRT (HR 2.7; 95% CI: 0.98– 7.92; p = 0.05) and violation of the CRT regimen (HR 2.8; 95% CI: 1.03–7.62; р = 0.04).

CONCLUSION: surgical treatment of recurrent SCAC is associated with a high risk of second recurrence, but remains the only potentially curative option for this category of patients. It is necessary to find ways to improve local disease control during surgical treatment.

AIM: to assess the functional outcomes following management of perianal fistulizing Crohn’s disease.

PATIENTS AND METHODS: a retrospective study was done from April 2018 to September 2024, comparing continence function before and after surgery (median follow-up 4.2 months) in 150 patients with perianal Crohn’s disease (pCD). Sphincter function was assessed before and after surgery using the Wexner scale and anorectal manometry. Uni- and multivariate binary logistic regression analyses were performed to identify risk factors for clinical anal incontinence (AI).

RESULTS: the incidence of clinical anal incontinence (AI), defined as a Wexner score of ≥ 2, was assessed in nonstoma patients and was 90/132 (68%) preoperatively and 84/119 (71%) postoperatively. No significant differences in frequency were observed (p = 0.84). However, a significant increase in Wexner scale scores was noted in the late postoperative period (preoperative median: 3 points [Q1; Q3: 1; 7]; postoperative median: 5 points [Q1; Q3: 1; 9]; p = 0.007). Univariate analysis identified factors associated with an increased risk of clinical AI after surgery: longer duration of perianal CD symptoms (OR = 1.17; 95% CI: 1.01–1.38; p = 0.04), a history of surgery for anal fistulas (OR = 0.33; 95% CI: 0.15–0.75; p = 0.008), a higher number of previous operations (OR = 2.16; 95% CI: 1.01–4.6; p = 0.046), including a greater number of previous incision and drainage procedures for perianal abscesses (OR = 1.85; 95% CI: 1.12–3.08; p = 0.017), and a higher number of rectal fistulas (OR = 2.25; 95% CI: 1.04–4.87; p = 0.039). However, multivariate analysis failed to confirm the statistical significance of these factors. The manometric incidence of AI was 120/150 (80%) preoperatively and 137/150 (91%) postoperatively (p = 0.0004). Patients with normal preoperative manometry had a higher incidence of postoperative AI (p = 0.02). The Average Anal Resting Pressure was below the reference range in 116 (77%) cases preoperatively and in 137 (91%) cases postoperatively, indicating a significant decrease after surgery (p = 0.001). No factors predisposing to an increased risk of manometric AI were identified.

CONCLUSION: the results obtained showed an increase in the rate of postoperative anal incontinence in patients with perianal Crohn’s disease. It is necessary to apply an individual approach to surgery, taking into account the patient’s medical history and current condition.

AIM: to assess the efficacy of immunotherapy in patients with locally advanced CRC and MSI.

PATIENTS AND METHODS: three clinical cases of patients with locally advanced colorectal cancer and microsatellite instability are presented.

RESULTS: all three patients experienced major clinical and radiological improvement shortly after the start of ICI treatment. The third patient developed a 2nd degree immune-mediated pneumonitis that necessitated hormonal therapy and ICI termination. This patient got a subsequent laparoscopic right colectomy which proved complete pathomorphologic response. Recurrent-free survival since the beginning of ICI treatment is 54, 30 and 18 months, respectively.

CONCLUSION: patients with locally advanced CRC and MSI even in case of unresectability may benefit greatly after immunotherapy. This makes it crucial to evaluate the presence of MSI in this patients.

AIM: to assess late functional outcomes and quality of life of restorative proctocolectomy with J-pouch in patients with ulcerative colitis.

PATIENTS AND METHODS: the retrospective study included 76 patients operated in 2013–2018. Quality of life and continence were assessed using the SF-36 questionnaire and the Wexner incontinence scale. The first survey was done in 2018–2019, and the second one — in 2025. Complete paired data were obtained from 49 (64.5%) patients. Paired comparisons between the two surveys were performed using the Wilcoxon signed-rank test. Associations between QoL and continence function were analyzed using multiple linear regression.

RESULTS: a significant decrease was detected in several SF-36 domains: general health (GH) 67 (50; 82) vs 57 (47; 75), p = 0.028; vitality (VT) 67 (50; 82) vs 57 (47; 75), p = 0.0008; mental health (MH) 72 (60; 86) vs 64 (52; 74), p = 0.013; and in the mental component summary (MCS) 51.1 (40.5; 55.1) vs 45.3 (38.7; 51), p = 0.013. No significant differences were found in the remaining domains. A marked increase in incontinence symptoms was noted over time: the median Wexner score increased from 1 (0; 2) to 4 (1; 10.5), p < 0.0001. However, no significant association was found between deterioration of continence and quality of life according to regression analysis. Female gender was identified as an independent predictor of lower QoL (p = 0,046).

CONCLUSION: over time, patients with a J-pouch demonstrated a significant decline in continence function and quality of life due to worse psychoemotional domains, while physical components remained relatively stable. No significant correlation was found between QoL and continence impairment.

AIM: to develop an algorithm for rectal injuries (RI) at the stages of medical evacuation (MEE), based on differentiated approach to surgery and indications for drainage of the pelvic spaces (PCS).

PATIENTS AND METHODS: in March 2023 — December 2024, 135 patients (aged 34.3 ± 4.2; 99.2% males) were included in retrospective study. The 1st group (n = 93) included patients with intra-abdominal RI. The 2nd group (n = 42) included patients with extraperitoneal RPK. The characteristics of the wounds, the combination of injuries with other organs and systems, type and volume of surgery were evaluated. In group with extraperitoneal injuries 18 patients underwent surgery with active drainage of the presacral space and 24 — standard bilateral perineal pelvic drainage. Pain, clinical and biochemical indicators were evaluated on the 1st and 3rd days.

RESULTS: RI suturing was performed in 28.5–30.2% of case, rectal resection — in 57.9%, more often in intraabdominal injuries — (69.8% vs 11.9% for extraabdominal; p < 0.05). Hartmann’s procedure was done in 21.5% of cases, and a loop colostomy — in 29% of cases. In 35.7% of clinical cases, a rectal resection was done due to injuries missed at previous stages. Necrotic changes in the pelvis developed on the 2nd day in 12.5% of cases, and on the 3rd day or more in 62.5% of cases with standard bilateral pararectal drainage. In the group with active drainage of the presacral space no major complications occurred.

CONCLUSION: the developed algorithm for rectal injuries is effective, active pelvic drainage is superior to standard one.

AIM: evaluate the effectiveness of new polymer membranes for prevention of intestinal anastomoses leakage in ex vivo experiment.

MATERIALS AND METHODS: the materials of the present study were new samples (groups No. 1–5) of multilayer polymer membranes (5 groups differing in composition with addition of various antibacterial agents, a contrast agent in different layers) and the membrane, the implanted biopolymer (group No. 6). Study design: experimental single-center comparative prospective with simple blinding. Study terms — 1 month. The end point of the study is the level of intraluminal pressure at the air expiration in the anastomosis zone. The effectiveness studies were conducted by pneumopressing (using an automatic tonometer) a section of the small intestine after applying a singlerow intestinal anastomosis, on which the test samples were placed. The pressure inside the single-row (group 7) and double-row (group 8) anastomoses was also measured without the use of membranes. The study used 7 cm long and 2 cm wide sections of the small intestine taken from ten male cadavers aged between 30 and 45. The samples were collected within 24 hours of death. Each group included 10 samples.

RESULTS: the highest median of pressure value (85 [79.5; 87] mm Hg) was observed in group 8 (double-row anastomosis), with a median difference of 0.5 compared to group 1 (84.5 [83; 85] mm Hg) (using membranes without antibacterial agents) and group 4 (84.5 [83.25; 86] mm Hg) (using membranes with Levofloxacin in the PVP layer and Yogexol in the sodium alginate layer). However, the values of group 8 are statistically significantly higher than the values of groups 6 (62 [60.5; 63] mm Hg) and 7 (63.5 [59.5; 65.75] mm Hg) by 23 (p = 0.002) and 21.5 (p = 0.004) respectively.

CONCLUSION: the study suggests that the mechanical shelter of the intestinal anastomosis with new membrane samples is a fairly effective method for preventing their failure.

AIM: evaluating effectiveness and safety of the method of fistula repair using a lateral rectal flap in patients with anal fistulas involving more than 1/3 of the external sphincter (complex anal fistulas).

PATIENTS AND METHODS: a single-centre, prospective, single-group study included 60 patients who underwent anal fistula repair using a lateral rectal flap (LRF). The check-up before and after the surgery was carried out using instrumental methods — transrectal ultrasound (TRUS) and sphincterometry. The majority of patients had an extrasphincteric fistula (41/60 (68.3%)), pararectal cavities were detected in 39/60 (65%) patients, including multiple cavities in 23/39 (38.3%). The late results were studied after 3–12 months. The median follow-up was 7 (4; 8) months. The primary endpoint was the rate of non-recurrence cases (treatment effectiveness), the secondary ones were the assessment of continence, pain syndrome, risk factors for unsatisfactory results (recurrence).

RESULTS: the effectiveness of the LRF method was 48/60 (80%; 95% CI 67.7; 89.2) cases. Sphincterometry and Wexner’s incontinence scale showed no worsening of continence after surgical treatment (1 (0; 3) point before the surgery and 2 (0; 3) points after 3–6 months (p = 0.68)). The assessment of risk factors for unsatisfactory results of LRF application revealed such factors as excess body weight (body mass index ≥ 30.7 kg/m²) (body mass index ≥ 30.7 kg/m²) (odds ratio (OR) = 1.14 (95% coincidence interval (CI) 1.02; 1.29), p = 0.02); purulent intersphincteric leaks (OR = 5.50 (95% CI 1.14; 26.6), р = 0.03); purulent ischioanal leaks(OR = 16.8 (95% CI 3.20; 7.55), р = 0.0009) and purulent pelviorectal leaks(OR = 7.86 (95% CI 1.69; 36.6), р = 0.008), as well as multiple purulent cavities (OR = 4.40 (95% CI 1.14; 16.9), р = 0.03).At the same time, the LRF method allows to achieve recovery in 28/39 (71.8%) patients with solitary cavities, and in 15/23 (65.2%) cases of multiple cavities.

CONCLUSION: the LRF method allows for the one-stage elimination of “complex” anal fistulas in 80% of cases, without worsening of anal continence. According to the Visual Analogue Scale, the median score did not exceed 3 for the entire follow-up period, what corresponds to a low level of pain; at the same time, the maximum intensity was noted on the 2–4 days after surgery, whereas by the 10 day almost all patients did not experience pain.

AIM: to improve the outcomes of perineal wound reconstruction after ELAPE for low rectal cancer by applying a new reconstructive technique.

PATIENTS AND METHODS: a cohort multicenter randomized controlled trial included 150 patients, allocated into three groups depending on the perineal wound reconstruction technique: new technique (n = 50), simple wound closure (n = 50), mesh repair (n = 50). The time of the reconstruction stage, blood loss, pain intensity, frequency of early (up to 30 days) (seroma, hematoma, suppuration, flap necrosis) and late (median 14 months) postoperative complications (fistulas, abscesses, perineal hernias, chronic pain syndrome) were studied; patient quality of life was assessed.

RESULTS: the time of the reconstruction stage was longer in the new technique group (50 [45; 55] min) compared to 20 [20; 25] min for simple closure and 35 [30; 40] min for mesh repair (p < 0.0001). Pain intensity on days 1, 3, and 5 was lower in the new reconstruction technique group (p = 0.005, p = 0.002, p = 0.0007). The frequency of early complications was 16% in the new technique group versus 32% and 24% in the comparison groups (p = 0.17). The differences were not statistically significant. Wound suppuration developed in 2 (4%) vs. 8 (16%) and 5 (10%), p = 0.43. Late complications were recorded in 2% of patients in the new reconstruction group versus 14% in each of the comparison groups (p = 0.07). The rate of chronic fistulas (0, 2 (4%), 4 (8%), p = 0.22), perineal hernia (1 (2%), 4 (8%), 3 (6%), p = 0.22). Quality of life indicators were significantly better in the new reconstruction group (p < 0.0001).

CONCLUSIONS: perineal wound reconstruction using the new technique after ELAPE for rectal cancer requires more time, but it provides reduced postoperative pain intensity, improved quality of life, and demonstrates a clinically significant trend towards reducing the frequency of early and late postoperative complications.

АIM: to assess the prognostic significance of markers of oxidative stress, collagen degradation and intra-abdominal hypertension in the development of colorectal anastomotic leakage.

PATIENTS AND METHODS: retrospective case-control study was conducted including 65 patients after colorectal resection: the study group (n = 43) comprised patients who developed anastomotic leakage, and the comparison group (n = 22) included patients with an uneventful postoperative course. The groups were comparable in terms of age, sex, operative time and intraoperative blood loss (p > 0.05). On postoperative days 2–3, serum levels of malondialdehyde (MDA), free hydroxyproline, conjugated dienes, ascorbic acid, lactate and serotonin, as well as intra-abdominal pressure (IAP), were measured.

RESULTS: Patients with CAL had significantly higher median levels of MDA (4,4 [3,9–4,7] vs 3,1 [2,4–3,6] nmol/ mL; p < 0.001), free hydroxyproline (18,0 [15,7–19,6] vs 12,7 [11,1–14,8] μmol/L; p < 0.001) and IAP (16,1 [14,2–17,9] vs 10.5 [8,8–15,1] mmHg; p < 0.001) on postoperative days 2–3 as compared with controls. ROC analysis showed good discriminative ability of free hydroxyproline for CAL: AUC 0.83 (95% confidence interval (CI) 0.72– 0.93; p < 0.001); at a cut-off ≥ 15 μmol/L, sensitivity was 79.1% (95% CI 63.9–89.9), specificity 77.3% (95% CI 54.6–92.2), positive predictive value (PPV) 87.2% (95% CI 72.6–95.7) and negative predictive value (NPV) 65.4% (95% CI 44.3–82.8). IAP ≥ 15 mmHg yielded an AUC of 0.78 (95% CI 0.65–0.90; p < 0.001), sensitivity 69.8% and specificity 72.7%; MDA ≥ 4.0 nmol/mL — AUC 0.80 (95% CI 0.68–0.91; p < 0.001), sensitivity 74.4% and specificity 77.3%. In multivariable logistic regression, free hydroxyproline (odds ratio (OR) 1.35; 95% CI 1.08–1.69; p = 0.009), IAP (OR 1.35; 95% CI 1.10–1.65; p = 0.004) and MDA (OR 2.86; 95% CI 1.25–6.56; p = 0.013) were identified as independent predictors of CAL. The combined three-marker model showed high prognostic accuracy: AUC 0.93 (95% CI 0.84–0.98; p < 0.001); p (Hosmer-Lemeshow test) = 0.34; Nagelkerke R² = 0.65.

CONCLUSION: comprehensive assessment of collagenolysis markers and intra-abdominal hypertension in the early postoperative period allows highly accurate prediction of the risk of anastomotic leakage

AIM: to assess the adherence of surgeons to various methods of diagnosis and surgical treatment of patients with extraperitoneal rectal wounds at different levels of medical care.

MATERIALS AND METHODS: in October 2024, an observational cross-sectional study for patients with extraperitoneal rectal wounds was done using an anonymous questionnaire online, in which 75 surgeons took part. Respondents were divided into four groups depending on the characteristics of the medical evacuation stage. Inclusion criteria: the respondent surgeon must have experience in providing surgical care at one of the listed levels of medical care. Exclusion criteria: the respondent has no experience in providing surgical care at the listed levels of medical care.

RESULTS: a survey of surgeons at various levels of medical care revealed a lack of or low internal consistency in most of the respondents’ answers at each level of medical care. A moderate degree of consistency was achieved when answering questions about the method and purposes of performing routine drainage of pelvic cellular spaces. In the answers to the question about the sequence of performing surgical techniques for extraperitoneal injuries of the rectum, the AC1 Gvet coefficient approaches the mean degree of agreement (0.383 (95% confidence interval: 0.119; 0.647)).

CONCLUSION: one of the options for unified approach to providing surgical care for extraperitoneal rectal wounds is to conduct a study using by the Delphi method with the involvement of a group of experts, followed by the development and implementation, based on a consensus decision, of algorithms for the treatment of this type of injury at the stages of medical evacuation.

AIM: to compare the treatment outcomes of rectal cancer patients using two regimens of total neoadjuvant therapy (TNT): short-course radiotherapy with three cycles of consolidating chemotherapy and long-course chemoradiotherapy with three cycles of consolidating chemotherapy.

PATIENTS AND METHODS: a prospective, Single-Center, Randomized Study. From September 2022 to February 2025, 125 patients were enrolled in the study. Of these, 64 were assigned to Group A and 61 to Group B. In Group A, patients received a short-course radiotherapy (RT) regimen followed by three cycles of consolidating chemotherapy with the XELOX regimen. Treatment response was assessed 10–18 weeks after the completion of radiotherapy. In Group B, patients received a long-course chemoradiotherapy (CRT) regimen followed by three cycles of consolidating chemotherapy with the XELOX regimen. Treatment response was assessed 10–18 weeks after the completion of chemoradiotherapy. The primary endpoint of the study is the rate of complete tumor response (pathological complete response, pCR).

RESULTS: the median tumor size was 50 mm (interquartile range, IQR: 24–123 mm) in Group A and 47 mm (IQR: 27–76 mm) in Group B (p = 0.3). There were no significant differences in the presence or absence of involved circular resection margin (p = 0.9) or extramural vascular invasion (p = 0.8) before treatment initiation. Both groups showed comparable results in terms of compliance (p = 1.0), tolerability (p = 0.7), and toxicity (p = 0.8) of radiotherapy. No statistically significant differences were found in the compliance (p = 1.0), tolerability (p = 0.8), and toxicity (p = 0.2) of chemotherapy. Surgical outcomes were also comparable regarding the rate of negative resection margins (p = 1.0), quality of mesorectal excision (p = 0.5), degree of tumor response to neoadjuvant treatment (p = 0.6), and postoperative complications (p = 0.8). The rate of complete tumor responses (both clinical and pathological) did not differ significantly between the groups. With a follow-up ranging from 3 to 35 months (median 18 months), the clinical complete response rate was 5/61 (8.2%) in Group A and 11/64 (17.2%) in Group B (p = 0.18). The pathological complete response rate was 9/53 (14.7%) vs. 6/51 (9.3%), respectively (p = 0.6). The overall complete response rate was 14/61 (22.9%) in the short-course RT and 17/64 (26.5%) in the long-course CRT group (p = 0.6).

CONCLUSION: the compared TNT regimens are comparable in compliance, tolerability, and toxicity. The combination of SCRT with consolidation chemotherapy in a neoadjuvant regimen is comparable in the frequency of complete responses compared with a CRT with consolidation chemotherapy.

AIM: to compare early and late results after segmental and extended resections in middle third transverse colon cancer.

PATIENTS AND METHODS: a retrospective study included 86 patients with middle third transverse colon cancer who underwent resection between 2017–2023. Patients were divided into segmental resection (SR) (n = 55) and extended colectomy (EC) (n = 31) groups. Intraoperative parameters, incidence, nature of postoperative morbidity and histopathological findings were evaluated. Late outcomes and functional results were analysed. Statistical analysis included regression models to identify complication predictors.

RESULTS: postoperative complications in the CP group were lower than after extended surgery — 11/55 (20%) versus 13/31 (41.9%) cases (p = 0.04). In multivariate analysis, independent predictors of an increase in the likelihood of complications were stapler anastomosis (OR = 9.48; 95% CI: 1.88–57.66; p = 0.008) and the pN2 (odd ratio (OR) = 3.63; 95% confidence interval (CI): 1.11–12.34; p = 0.03). The volume of resection had no significant effect on the risk of complications (OR = 2.8; 95% CI: 0.97–8.33; p = 0.11). With EC, more lymph nodes were removed than with SR — 20 (15.7; 32.2) versus 29 (21; 48) (p = 0.005), while the rate of their metastatic lesion was 0 (0; 4) for both groups (p = 0.44), and the 5–year overall survival with a median follow-up of 52 (34.7; 68.5) months was 86% for SR versus 78.3% for EC (p = 1.0) did not differ significantly between the groups. The study of the frequency of bowel movements in the late period was 2 (1;2) times/day in both groups (p = 0.97), as well as the shape and consistency of faeces (type 3 prevailed according to the Bristol scale — 31/46 (67.4%) for SR and 20/28 (71.4%) for EC (p = 0.8)) revealed no significant differences between the groups.

CONCLUSION: postoperative complications in the segmental colon resection group is lower than in the dilated colon group. The volume of surgery was not an independent predictor of complications. The likelihood of their development was increased by the use of stapler for anastomosis and the pN2 criterion. The late results in the groups did not differ.

AIM: to perform language adaptation into Russian and cross-cultural validation of PROM-HISS for its use in the Russian Federation.

METHODS: the questionnaire was translated by two independent translators, then combined and discussed with a working group including a proctologist and medical translation specialists. A back-translation was conducted to ensure quality control and conceptual fidelity to the original. Ten patients with varying stages of chronic haemorrhoids (Goligher’s classification) participated in cross-cultural validation using cognitive interviews. The clarity, completeness, and relevance of the questions and answer options were discussed.

RESULTS: the translated version, PROM-HISS_RU, has good external and content validity and adequately reflects the haemorrhoids symptoms, their impact on quality of life, and treatment satisfaction. Participants rated the questionnaire as understandable, informative and compact. During the validation, minimal language and terminology corrections were made while maintaining the semantic structure of the questionnaire.

CONCLUSION: the PROM-HISS_RU questionnaire is an effective tool for assessing the symptoms of haemorrhoids, its impact on daily activities and satisfaction of patients with treatment.

AIM: to present a clinical case of extraperitoneal rectal wound complicated by Fournier’s gangrene, within the framework of multi-stage surgical treatment.

PATIENTS AND METHODS: patient H., sustained a shrapnel wound to the perineum with non-destructive extraperitoneal damage to the middle rectum. At the 2nd level of medical care, surgical treatment included end sigmostomy, suturing of the rectal wound, bilateral pararectal drainage. Three days after, a surgical intervention was performed at the 4th level of medical care for the developed complication — Fournier’s gangrene. On the 14th day, the patient was discharged for outpatient treatment.

RESULTS: this clinical case showed that the end colostomy in case of non-destructive extraperitoneal rectal injury became the reason for refusing to perform an important element of the 4D concept — antegrade distal washout. Thus, the unsanitized disconnected section of the rectum most likely became the source of a formidable complication — Fournier’s gangrene. In addition, suturing the defect of the rectal wall in this clinical case was not a priority element of the 4D concept, and routine pararectal drainage did not have a significant impact on the prevention of infectious complications.

CONCLUSION: extraperitoneal rectal wounds are associated with a high risk of developing life-threatening complications. Surgical treatment of this category of victims at various stages of medical evacuation should be based on a personalized approach, depending on the nature of the injury, the patient’s condition, the experience of the medical staff, and the medical tactical situation. Despite the difficulties in continuity between the stages of medical evacuation in the system of multi-stage surgical treatment, timely diagnostiсs and treatment of complications can minimize the consequences of combat surgical trauma.

AIM: to assess efficacy of antibacterial prevention for postcoagulation syndrome after endoscopic removal of colon neoplasms.

MATERIALS AND METHODS: literature search and meta-analysis were performed in accordance with the PRISMA guidelines using the PUBMED search system in the Medline electronic database. The systematic review included all studies devoted to antibacterial prophylactic of postcoagulation syndrome after endoscopic submucosal resection neoplasms of colon.

RESULTS: the analysis included 5 studies — 1055 patients, 546 in the antibiotic prevention group and 509 in the group without it. Postcoagulation syndrome was lower in antibacterial prophylaxis group 5,9% vs 16,1% without antibacterial prevention group (OR = 0.30; 95% CI: 0,09–0,96; p = 0.04).

CONCLUSION: antibiotic prophylactic reduces the incidence of postcoagulation syndrome after endoscopic removal of epithelial neoplasms of the colon.

The mechanisms of development, methods of diagnosis and treatment of solitary rectal ulcer syndrome (SRUS), including the possibility of using autologous stem cells obtained from adipose tissue in this pathology are described. Solitary ulcer syndrome of the rectum (SRUS) is a chronic, recurrent disease that does not have specific symptoms, with unclear aetiology and pathogenesis, variable endoscopic picture of inflammatory changes in the mucous membrane of the rectum. Diagnosis of SRUS is difficult in the vast majority of cases. There is no general consensus on the algorithms for treating SRUS to date. Treatment methods can be different, both conservative and surgical. However, at the moment there are no randomized controlled trials on late results of treatment. The variety of treatment approaches of SRUS reflects both the presence of a large number of unresolved issues and the relevance of further research, including the use of cellular biotechnology.

Lipoma is a common benign subepithelial neoplasm of mesenchymal origin that develops slowly from adipose tissue in the gastrointestinal tract. Most lipomas occur in the colon, accounting for 60-75% of cases, with less frequent occurrences in the small intestine, esophagus, and stomach. Diagnosis is typically made through endoscopic examination, while endosonography can provide more specific information. In endosonographic imaging, lipomas appear as homogeneous, hyperechoic masses originating from the submucosa (third layer). If the lipoma grows or becomes malignant, additional tests such as forceps biopsy, step biopsy, or fine needle aspiration under endoscopic ultrasound guidance can be performed for morphological verification. Treatment is recommended if the lipoma causes symptoms like pain, obstruction, or bleeding, or if it exceeds 2 centimeters in size. For asymptomatic lipomas, observation protocols may involve regular endoscopic assessments based on size and location to monitor for any changes.