OBJECTIVE: to evaluate oncological outcomes of surgical procedures performed in emergency conditions for complicated colorectal cancer. MATERIALS AND METHODS: we studied data of 1098 patients who underwent emergency surgery for complicated colorectal cancer in hospitals of Smolensk during the period from 2001 to 2013. RESULTS: 888 pathology reports of specimen assessment were analyzed. In 33 (11,5%) of 286 cases of rectal cancer distal resection margin was positive and 102 (35,7%) cases were CRM(+). Tumor growth was also registered at the distal margin in 4 (6%) of 67 patients with rectosigmoid cancer. In the majority of cases (68,1%) the lymph node harvest did not exceed 3. 12 or more lymph nodes were assessed in 50 (5,6%) of888 removed specimens only. CONCLUSION: The analysis of treatment results revealed that inadequate number of lymph nodes examined as well as R1 resection affected cancer-specific survival.

Colonoscopy with a forward-viewing camera leaves regions that are not visualized in detail. Thus development of video-enoscopy systems with wide angle of view is needed. Full-spectrum colonoscopes providing image of Ultra HD 4K quality are now available in Russia. MATERIALS AND METHODS. Seventy patents were assessed with a full-spectrum colonoscope. In 51 (72,8°%) of them the procedure was performed also for physician's training purposes. Fifteen (21,4%) patients underwent simultaneous full-spectrum and forward-viewing colonoscopies, while in 4 (5,7%) full-spectrum endoscope was used to visualize lesions that were non-assessable with traditional equipment. RESULTS. Applying Jull-spectrum colonoscopy for diagnosis resulted in detecting 170 polyps in 51 patients (polyp detection rate was 47,1%). Simultaneous use of full-spectrum colonoscope after forward-viewing equipment led to 9 additional polyps detection in one patient and 23 additional polyps in another one. In 7 patents full-spectrum colonoscopy allowed detection of polyps that were not found via forward-viewing equipment. CONCLUSION. During full-spectrum colonoscopy inner colonic surface can be visualized with an angle of view of 330° which is twice more than video-capturing area ofa standard forward-viewing endoscope. The equipment allows to significantly increase adenoma detection rate.

AIM to assess the efficacy of combination of laparoscopy and protocol of enhanced recovery in patients with colorectal cancer. MATERIALS AND METHODS. Between 2008-2016 466 patients were randomly allocated into 3 groups. Of them 266 of received perioperative treatment according to enhanced recovery protocol, 191 had routibne open procedure (group 2) and, 75 had laparoscopic operation (group 1). Patients underwent the following procedures: right hemicolectomy (n=53), left hemicolectomy (n=32), sigmoidectomy (n=55), abdomeno-perineal excision (n=67) and low anterior resection of rectum(n=201), other operation - 58. The following variables were analized: operating time, intraoperative blood loss, time of first flatus and defecation, morbidity (wound infections, anastomotic leakage, peritonitis, postoperative ileus, urinary disorders, thrombosis, cardiopulmonary complications). RESULTS. Groups were comparable in gender, comorbidities, body mass index, types of operations. Operating time did not differ significantly between 3 groups. Intraoperative blood loss was higher in conventional group. The time offirstflatus and defecation were better in group 1 and 2. Mortality rate was similar. Morbidity was lower in group 1 and 2 compared with conventional group: wound infections 1,3%, 3,1% vs 9%, anastomotic leakage 4%, 5,5% vs 9%, ileus 1,2 vs 5,4%, peritonitis 2,6%, 1,5% and 3,5%, bowel obstruction caused by the adhesions 0%, 6,8% vs 5,5%. Reoperation rate was 4%, 4,7% vs 5,5%, consequemntly. CONCLUSION. Combination of laparoscopic surgery withenhanced recovery program provides better results of treatment.

AIM. To develop tactics of treatment for post-traumatic anal sphincter insufficiency in emergency surgery. MATERIALS AND METHODS. 472 patients with anal sphincter insufficiency were treated between 1977-2015. Of them 125 had conservative therapy. Surgical treatment was performed in 347 patients. Twenty-four patients had emergency procedure. RESULTS AND CONCLUSIONS. The success of the rehabilitation of these patients depends on the timely and adequate surgical care at the time of the sphincter injury. 3 degrees of perineum tears in labor should be sutured by experienced obstetricians and only in layers. Sphincteroplasty without colostomy is indicated within 24 hours after injury, while later admission ot hospital requires defunctioning stoma. Gunshot sphincter damage require wound debridement without sphincteroplasty and defunctioning stoma.

The article analyzes the functional state (evacuation functions, continence) and innervation of the pelvic floor muscles in patients with rectocele and combination rectocele with internal rectal intussusception, with complaints of obstructive defecation. AIM. The study of the functional state of the pelvic floor muscles in patients with obstructive defecation syndrome (ODS). MATERIALS AND METHODS. The study included 224 women with complaints of obstructive defecation, without pelvic floor surgery. On physical examination, all patients were detected signs of rectocele. The average age - 49,9±15,0 years. 52 (23,2%) patients had complaints to the fecal incontinence of various components. Diagnostic algorithm: physical examination defecography, rectal functional study (high resolution manometry (HRAM), evacuation test, comprehensive sphincterometry, pudendal nerve study). RESULTS. Frequency of functional disorders of defecation (FDD) according to objective methods of study among patients with ODS is high and amounts to 64.7%. In this case, there are no differences in the frequency FDD in patients with a combination of rectocele and internal intussusception compared to patients with only rectocele. There were no correlation between the frequency of anal sphincter failure and FDD. We identified some patients with subclinical incontinence, without complaints but with reduced manometric values and anal sphincter contractility. We have proved the absence of correlation between the presence or absence of pelvic floor muscle innervations violations in the form of neuropathy n. pudendus and the presence or absence of FDD. CONCLUSION. FDD can cause unsatisfactory results of surgical treatment of patients with ODS, even after the restoration of the anatomic relationships due to complaints of evacuation violation. ODS diagnostic algorithm should include not only an assessment of evacuationfunction (HRAM and evacuation test), but also sphincterometry, to assess the content function.

AIM. To compare results surgery ofcolorectal cancer with resection or radiofrequency thermoablation of liver metastasesi. MATERIALS AND METHODS. Fifty seven patients were included into study. In first group (n=24) liver resection was performed simultaneously with primary tumor surgery; in the second group (n=33) patients underwent local thermal destruction of metastases. RESULTS. Postoperative complications developed in 2 (8,3%) patients of group I and 4 (12,1%) in group II. In group II, the postoperative in-hospital mortality rate was 5,8% (2 patients) due to failure of colonic anastomosis withfecal peritonitis. The disease-free period in group I was 14,4±3,2 months. The 3-year survival rate was 39%, with the median survival of 32,5 months. In group II, the 3-year survival rate was 27%. CONCLUSION. Resectable liver metastases should undergo resection, if there are no adverse factors. This study shows that liver resection is a more effective treatment than radiofrequency thermoablation.

AIM. To improve results of latex ligation of internal hemorrhoids. MATERIAL AND METHODS. Results of 432 latex ligation of hemorrhoids were analyzed. The average age of the patients was 42,1 ± 7,3 years, 293 (67,8%) patients had third or the fourth degree of the disease. A new method of latex ligation of the mucosa and submucosa of the lower rectum with the aim to close hemorrhoidal vessels and lifting hemorrhoidal tissue complex was suggeste and usedfor III-IV degree hemorroids. RESULTS. In the early postoperative period complications not requiring reinterventions developed in 5 patients. In the late period good results were obtained in 87,3% of patients. CONCLUSION. Suggested modified latex ligation in the treatment of chronic hemorrhoids is minimally invasive, simple and low cost. It extends the indication of this method for hemorroids of advanced stages.

This observation from practice shows modern possibilities of diagnostics and treatment of antibiotic associated gut infection in patient with cancer.