AIM: to evaluate the risk of recurrent intussusception after removal of hamartomas in patients with Peutz-Jeghers syndrome (PJS) and to analyze the safety of endoscopic removal of small bowel hamartomatous polyps in this patient population.

PATIENTS AND METHODS: single-center retrospective study evaluated the endoscopic management of confirmed PJS followed from January 2022 to December 2025 in 39 patients. There were 103 elective procedures: 1) balloonassisted enteroscopy (BAE) with polypectomy (n = 92), and 2) intraoperative enteroscopy (IOE) (n = 11). The primary endpoint was the recurrent intussusception confirmed by imaging. Time-to-event analysis was performed using the Nelson-Aalen method.

RESULTS: a total of 686 small bowel hamartomatous polyps were removed. The median number of polyps removed per procedure was 5 (IQR 3–8) for BAE and 10 (IQR 8–17) for IOE. Median operation time was 90 (58–115) minutes for BAE and 300 (200–360) minutes for IOE. Complications occurred in 11/103 (10.7%) cases: 7/92 (7.6%) with BAE and 4/11 (36.3%) with IOE. Most complications were managed endoscopically — 5/7 (71.5%) in the BAE group and 1/4 (25.0%) in the IOE group. An active endoscopic strategy using BAE enabled organ-sparing treatment of intussusception in 13 out of 15 (86.7%) cases. The cumulative probability of recurrent intussusception within the first year of follow-up was 20.4% (95% CI 0,0–43.9), and the median time to event was 23.9 months.

CONCLUSIONS: balloon-assisted enteroscopy as a minimally invasive approach demonstrates high efficacy in resolving intussusception. Despite treatment, a significant risk of recurrent intussusception persists, necessitating longterm follow-up. BAE shows an acceptable safety profile, whereas IOE is associated with a higher complication rate, reflecting its use in complex cases.

AIM: to evaluate the outcomes of surgery for perianal fistulas using draining seton in perianal fistulizing Crohn's disease (CD).

PATIENTS AND METHODS: retrospective study included 199 patients with perianal fistulas associated with CD who underwent surgical treatment with draining latex seton placement between February 2017 and October 2024. Transrectal ultrasound (TRUS) of the rectum was performed for preoperative and postoperative imaging. The endpoints included positive response to treatment and partial improvement rate, primary treatment failure, recurrence rate, and rate of reinterventions.

RESULTS: positive response to treatment, according to predefined criteria, was achieved in 121/199 (61%) patients. A second surgical stage was performed in 89/121 (74%) patients, with a median interval of 12 months (IQR: 7–18) between procedures. Recurrence occurred in 7/121 (6%) patients, with a median time to recurrence of 14 months (IQR: 11–16). In 32/199 (16%) cases, a partial improvement was noted — a decrease in the size of the collections or their number. Primary failure due to persistent undrained collections was diagnosed in 46/199 (23%) patients. In 25 (54%) of these cases, progression of perianal disease was noted postoperatively, characterized by new fistula tracts and enlargement of existing collections. Repeat drainage with seton placement was performed in 33/46 (72%) patients. In 11/46 (24%) cases, due to an aggressive disease course, an abdominoperineal resection (APR) was performed.

CONCLUSION: the results largely confirm that draining seton placement is only one component of a multimodal strategy for perianal Crohn's disease (pCD). Therefore, further studies are warranted to identify and analyze factors influencing healing, recurrence, and progression rates of perianal fistulas.

AIM: to compare laser coagulation of the pilonidal sinus and its excision.

PATIENTS AND METHODS: a retrospective study included 113 patients with chronic inflammation of the pilonidal sinus without abscess, with a track no more than 9 cm. The main group underwent laser coagulation of the ECC, and the controls underwent its excision. The pain level, the healing time of postoperative wounds, and the postoperative relapses rate were assessed from days 2 to 6. The primary point of the study was the rate of wounds epithelialization on day 90.

RESULTS: on day 90, wound healing occurred in 60/60 (100.0%) patients of the main group and 39/42 (92.9%) patients of the control group, p = 0.067. In the remaining 3/42 (7.1%) patients of the control group, wounds healed on day 95 in 2/42 (4.8%) cases and on day 240 in 1/42 (2.4%). The median duration of healing of postoperative wounds was 45 (35; 60) days in the main group and 85 (65; 90) days in the control group, p < 0.001. Recurrence of the disease occurred in 3/60 (5.1%) cases in the main group and in 2/42 (4.8%) cases in the control group, p = 0.104.

CONCLUSION: laser coagulation is a highly effective and safe method of treating uncomplicated forms of pilonidal disease. The protocol of laser exposure and postoperative management has demonstrated its convenience and a good early result. It can be used as a variant of laser coagulation of the epithelial coccygeal passage.

OBJECTIVE: to analyze the incidence of colon cancer in the Siberian (SFD) and Far Eastern Federal Districts (FEFD) for 2019–2024.
MATERIALS AND METHODS: a retrospective descriptive study of depersonalized data on the incidence of colorectal cancer (colon (C18), rectosigmoid junction (C19), rectum, anus and anal canal (C20-21) — ICD-10 codebook) was conducted for the period from January 2019 to December 2024 according to absolute data (the number of malignant neoplasms detected for the first time in life (table 2000) taking into account gender and age) of reporting forms No. 7 “Information on malignant neoplasms” of the subjects of the Siberian Federal District and the Far Eastern Federal District. Population data by gender and age for federal district subjects were provided by the Federal State Statistics Service of the Russian Federation. Standardized (world standard SEGI per 100,000 population (0/0000)) and age-specific incidence rates were calculated for 2019–2021 and 2022-2024. Differences in rates between periods were assessed using 95% confidence intervals (CI).
RESULTS: in the structure of morbidity, colorectal cancer (CRC) consistently ranks 3rd among both men (12.0 and 11.1% in the Siberian Federal District and the Far Eastern Federal District) and women (11.5 and 10.8%). In the Siberian Federal District, standardized incidence rates when comparing 2019–2021 and 2022–2024 increased in the male population from 34.8 (95% CI 34.2–35.4) to 40.4 (95% CI 39.7–41.1) 0/0000 and in the female population from 24.4 (95% CI 24.0–24.9) to 26.7 (95% CI 26,2–27.1) 0/0000. In the Far Eastern Federal District — from 29.5 (95% CI 28.7–30.4) to 33.0 (95% CI 32.1–33.9) 0/0000 and from 22.3 (95% CI 21.7–22.9) to 24.4 (95% CI 23.8–25.1) 0/0000. In the Siberian Federal District, an increase in the incidence of CRC in men and women is observed after 45 years of age. The peak incidence occurs at 75–79 years, reaching 420.2 0/0000 in men and 252.0 0/0000 in women. In the FEFD, among men, the incidence increase is observed after age 50, with a peak at 75–79 years (377.3 0/0000); among women, after age 55, with the highest age-specific rate at 75–79 years (249.3 0/0000).
CONCLUSION: analysis of colorectal cancer incidence in the Siberian and Far Eastern Federal Districts revealed an increase in rates among both sexes, with the highest values in age groups over 70 years, which indicates the relevance of introducing territorially adapted colon cancer screening programs, with a focus on high-risk groups taking into account age.

AIM: to compare the early results of pilonidal disease (PD) management using laser obliteration with traditional methods.

PATIENTS AND METHODS: a retrospective, multicenter, non-randomized study was conducted. Between January 2014 and December 2024, a total of 128 patients who underwent surgical treatment for the fistulous form of the pilonidal sinus (PS) were registered. Twenty-four patients were excluded from this cohort, since the time of follow-up did not exceed 24 months. Thus, 104 patients of both genders were included in the final analysis. Patients were divided into 3 groups: Group 1 — 36 patients (34.6%) underwent excision pilonidal sinus — suturing the edges of the wound to the bottom, Group 2 — 30 patients (28.9%) underwent Bascom-II surgery, Group 3 — 38 patients (36.5%) underwent laser ablation. The primary endpoints were the operation time, hospital stay, and healing time. Secondary endpoints included assessment of the severity of postoperative pain syndrome, periods of disability, healing time and time to recurrence.

RESULTS: the mean operation time in Group III patients was significantly shorter than in Groups I and II (p < 0.001). The hospital stay in Group III was shorter than in Groups I and II (p < 0.001). Pain syndrome after laser ablation was significantly less than in patients of Groups I and II (p < 0.001). Also, the pain syndrome in Group II patients was less than in Group I (p < 0.001). The duration of disability after laser ablation was shorter — 6.5 (3–7) days, compared to 21 (20–23) and 15 (15–21) days in Groups I and II, respectively (p < 0.001). In 5 (16.6%) patients of Group II, a ligature fistula developed within 30 to 90 days, which was resolved by a session of vertical ablation. Disease recurrence occurred in 4 (6.4%) patients of Group III within 120 to 180 days. The recurrence rate in Groups II and III was not statistically significant (p = 0.093). All recurrences were associated with complex forms of PD. CONCLUSION: laser ablation provides a short recovery period and a rapid return to daily life. However, despite its apparent simplicity, the technique requires experience. Effectiveness is achieved when the fistula tract is linear and free of cavities. At the same time, primary wound closure in the Bascom-II procedure has its advantages: a less pronounced pain syndrome compared to patients in Group I, reduced sick diability time, and faster wound

OBJECTIVE: the aim of this study is the effect of PRP application on the outcomes of chronic anal fissure treatment and to analyze the factors associated with the rate of anoderm defect epithelialization.

PATIENTS AND METHODS: a single-center prospective randomized controlled trial (NCT07268261) was conducted from September 2023 to November 2025. We compared the outcomes of fissure excision (FE) combined with botulinum toxin type A (BTA) injection at a dose of 40 units and platelet-rich plasma injection (FE+BTA+PRP - study group) versus FE combined with BTA (FE+BTA - control group). After applying the exclusion criteria, 125 patients were included in the final analysis: 60 in the study group and 65 in the control group. Cellular composition of plasma was assessed using a hematology analyzer in 51 (85.0%) of 60 patients in the study group; among them, 29 patients underwent blood collection in two-component tubes (Subgroup A), and 22 patients underwent collection in single-component tubes (Subgroup B). The comparative analysis included assessment of wound epithelialization rate on 15, 30, 45 and 60 postoperative days, analgesic requirements, quality of life according to the SF-36 scale, platelet and leukocyte concentrations in PRP, as well as ROC analysis of the prognostic significance of the platelet profile.

RESULTS: on the 60th day, the rate of postoperative wound healing was comparable in both groups, up to 43/60 (71.7%; 95% confidence interval [CI]: 58.6–82.5) cases in the FE+BTA+PRP group and 47/65 (72.3%; 95% CI: 59.8–82.7) cases in the FE+BTA group (p=0.936); on the 15th day, postoperative wound epithelialization was not observed in any patient; on the 30th day, wound healing occurred in 11/60 (18.3%) patients in the FE+BTA+PRP group and in none in the FE+BTA group (p=0.0003); on the 45th day — in 18/60 (30.0%) versus 3/65 (4.6%) patients (p=0.0001), respectively. The rates of wound healing depending on the type of tubes used on the 60th day postoperativ were comparable: in subgroup A (using two-component tubes), healing was observed in 21/29 (72.4%) cases, and in subgroup B (using single-component tubes) - in 16/22 (72.7%) cases; on the 30th day, epithelialization occurred in 11/29 (37.9%) cases in subgroup A and in none in subgroup B (0/22; 0%) (p=0.01). By 45th day the rate of postoperative wound healing increased in both subgroups: up to 51.7% (15/29 cases) with usage of two-component tubes and to 13.6% (3/22 cases) - with single-component tubes (p=0.007). A significant reduction in analgesic requirements and improvement in quality of life were noted in the study group. After centrifugation, the platelet level in two-component tubes was 397 × 10³/μL (346; 481), which was statistically significantly higher compared to single-component tubes at 239 × 10³/μL (106; 374) (p=0.001). The factor that statistically significantly increased the odds of epithelialization in univariate logistic regression analysis was the platelet level on the 30th day (OR=1.01; 95% CI: 1.00–1.02; p=0.008) and on the 45th day (OR=1.01; 95% CI: 1.00–1.01; p=0.007). The ROC analysis confirmed that a platelet concentration ≥452×10⁹/L in PRP is a statistically significant predictor of postoperative wound epithelialization time (p=0.001).

CONCLUSION: intraoperative administration of low-leukocyte PRP in the surgical treatment of chronic anal fissure significantly accelerates postoperative wound epithelialization, reduces pain syndrome, and improves patients' quality of life. To optimize healing time, it is preferabli to achieve a platelet concentration in PRP of at least 452 × 10⁹/L.

AIM: to analyze the accumulated experience of organ-preserving treatment for large and gigantic colorectal neoplasms and to identify risk factors associated with postoperative adverse events.

PATIENTS AND METHODS: 1,858 endoscopic operations were performed between October 2016 and July 2024. Of these, 1191/1858 (64.1%) had submucosal dissections, 471/1858 (25.3%) neoplasms were removed by endoscopic mucosal resection with a circular incision, and 196/1858 (10.6%) by fragmentary mucosal resection with a circular incision. The median size of the removed tumors was 35 (25; 40) mm. The data on the characteristics of patients and neoplasms, the operation time, the morphology and the rate of postoperative adverse events were analyzed. Based on the data obtained, the risk factors for adverse events after endoscopic removal of colon tumors were assessed.

RESULTS: postoperative adverse events occurred in 275/1856 (14.8%) patients: bleeding occurred in 33/1856 (1.8%) cases, delayed perforation occurred in 3/1856 (0.2%) patients. Postcoagulation syndrome developed in 239/1856 (12.9%) patients. According to the results of the multivariate analysis, only one independent predictor of the development of postcoagulation syndrome was identified — the duration of surgery. According to the result of the ROC analysis conducted on the basis of factor analysis, it was revealed that the cut-off point is the duration of the operation ≥ 93 minutes, the area under the ROC curve (AUC) = 0.93 ± 0.01 (p < 0.001).

CONCLUSIONS: endoscopic removal of epithelial colorectal neoplasms is safe. The most common adverse event is postcoagulation syndrome, which requires careful monitoring in the postoperative period for timely differential diagnosis, which will make it possible not to miss a more serious complication, such as delayed perforation. However, further research is needed to prevent postcoagulation syndrome.

OBJECTIVE: to develop and internally validate a prognostic model of adverse events after endoscopic removal of colorectal neoplasms.

PATIENTS AND METHODS: a retrospective analysis of medical records was conducted from January 2024 to June 2025. 3753 patients were included; all available preoperative variables were assessed as potential predictors. Sequential univariable and multivariable binary logistic regression analyses were performed. Internal validation was conducted using bootstrap resampling (B = 1000) with division into training and test samples in a ratio of 7:3.

RESULTS: multivariable logistic regression identified the following independent predictors of adverse events: arterial hypertension (odds ratio (OR) = 2,86; 95% confidence interval (CI): 1,71–4,79; p<0.001) and maximum neoplasm size (OR = 1,04; 95% CI: 1,03–1,05; p<0.001). Protective factors included JNET classification 2a and lower (OR = 0,07; 95% CI: 0,04–0,10; p<0.001), 0-I (p+s) (OR = 0,45; 95% CI: 0,23–0,88; p=0,019), and left-sided localization (OR = 0,23; 95% CI: 0,14–0,36; p<0.001). The variables CHD (p=0,243) and LST-NG (p=0,705) did not significantly influence the adverse outcome. The model demonstrated excellent discrimination (AUC = 0,894; 95% CI: 0,857–0,929 (overall sample).

CONCLUSION: the developed model demonstrated high discriminative performance for predicting adverse outcomes after endoscopic colorectal neoplasm removal and may serve as the basis for a patient routing algorithm between day-case and inpatient settings.

INTRODUCTION: the most pathogenetically justified treatment for adenomatous polyposis syndrome (APS) is restorative proctocolectomy with ileal pouch formation (RP+IPF). Currently, there are no specialized or universally accepted tools in global practice for assessing the quality of life of patients with ileal pouch and pouch-anal anastomosis based on the functional characteristics of bowel function.

AIM: to evaluate the functional outcomes after restorative proctocolectomy with ileal pouch formation for APS and to identify factors negatively affecting the quality of life of operated patients.

PATIENTS AND METHODS: between January 2013 and July 2024, 244 patients underwent RP+IPF for APS. Indications for surgery included the presence of more than 100 colonic polyps and/or histologically confirmed colorectal cancer in the setting of multiple (more than 20) colonic polyps. Patients operated on before 2019 underwent demucozation of the distal rectum and formation of a stapled pouch-rectal anastomosis at a height of 6-8 cm from the anal verge. In the group of patients operated on after 2019, the rectum was transected transabdominaly at the level of the upper edge of the anal canal, and a pouch-anal anastomosis was also created using a stapling device. All patients had a diverting ileostomy. For the measurement of quality of life, patients with > 6 months past ileostomy closure were asked to complete a Russian-validated questionnaire assessing the score of low anterior resection syndrome (LARS). A multivariate analysis was also performed to identify risk factors for the development of severe functional disorders leading to reduced quality of life.

RESULTS: the LARS questionnaire was completed by 176 patients (86 men and 90 women) with a median age at surgery of 31 (18-63) years. Forty-five patients (25.6%) underwent surgery with rectal demucozation, 121 (68.8%) - with creation of a stapled pouch-anal anastomosis, and 10(5.6%) patients underwent a hand-sewn pouch-anal anastomosis. The median bowel movement frequency was 6 times per day (range 2-15), and the median frequency of nocturnal bowel movements was 1 (range 0-5). Major LARS (≥30 points) were noted in 17 patients (9.7%). According to multivariate (binary logistic) regression analysis, risk factors for the development of severe functional disorders leading to reduced quality of life were: age at surgery >34 years (OR 6.82; 95% CI 1.8-25.9; p=0.004), performing rectal demucozation (OR 49.9; 95% CI 5.7-440.6; p=0.005), and formation of a hand-sewn pouch-anal anastomosis (OR 39.2; 95% CI 3.5-439.2; p=0.003).

CONCLUSION: the use of the LARS questionnaire in patients after RP+IPF for APS allows to evaluate the quality of life of operated patients and to identify the subgroup with significantly reduced indicators. To prevent severe functional disorders, avoiding the use of rectal demucozation appears preferable, while the method of creating stapled pouch-anal anastomosis should be considered the priority.

INTRODUCTION: in patients with adenomatous polyposis syndrome (APS), extracolonic manifestations are often detected. According to many researchers, desmoid tumors are the most common cause of death in patients with APS who underwent prophylactic bowel removal before polyps’ transformation into colorectal cancer. The inconsistent data in the current literature on the predisposive factors to the development of desmoid tumors in patients with APS prompted us to conduct our own research.

AIM: to evaluate the frequency of desmoid tumors in patients with adenomatous polyposis syndrome and to identify independent risk factors for the development of desmoid tumors.

PATIENTS AND METHODS: the single-center retrospective study included patients who underwent treatment for adenomatous polyposis syndrome and subsequent monitoring between January 2013 and January 2025. After the surgical stage of treatment, the patients were included in a long-term dynamic outpatient monitoring program. As part of this program, patients underwent annual endoscopic examinations of the upper and lower gastrointestinal tract, as well as CT scans of the chest, abdomen, and pelvis with intravenous contrast. The primary endpoint of the study was the detection of a desmoid tumor in a patient with APS. A univariate analysis followed by a logistic regression analysis was conducted to identify independent risk factors for the development of desmoid tumors in patients with APS.

RESULTS: In 79 (21.4%) out of the 369 patients included in the study desmoid tumors were detected on average, 18 (6 to 60) months after surgery for APS. In 90.1% of patients with a desmoid tumor, a pathogenic variant in the APC gene was detected. Based on the ROC analysis, it was found that the localization of pathogenic variant beyond codon 876 in the APC gene is more strongly associated with the development of desmoid tumor (AUC=0.60, p=0.01). As a result of the logistic regression analysis, it was revealed that the localization of the pathogenic variant in the APC gene beyond codon 876 (OR=2.15, 95% CI: 1.20-3.83, p=0.0097) and open access during surgery (OR=2.09, 95% CI: 1.18-3.71, p=0.0119) served as independent risk factors for the development of desmoid tumors in patients with APS.

CONCLUSION: the incidence of desmoid tumors detection in the studied cohort of patients with APS was 21.4%. The high risk of extraintestinal manifestations of APS confirms the need for long-term regular monitoring of patients after colorectal surgery, especially in the high-risk group – with the location of the pathogenic variant in the APC gene beyond codon 876 and/or after open surgery.

AIM: to perform a comparative analysis of the surgical capabilities and clinical indications for pharyngeal reconstruction using the ileocolon flap and the jejunal flap.

PATIENTS AND METHODS: the outcomes of upper aerodigestive tract reconstruction were analyzed in 35 oncological patients after laryngectomy with partial or circumferential resection of the hypopharynx. The ileocolon flap was used in 17 patients, while a jejunal flap combined with simultaneous or delayed tracheoesophageal puncture and voice prosthesis placement was used in 18 patients. The features of surgical technique, the extent of the donor-site stage, the possibilities of voice rehabilitation, and the factors influencing the choice of reconstruction method were evaluated.

RESULTS: both types of visceral reconstruction provide restoration of the alimentary tract and enable oral feeding. The ileocolon flap allows one-stage reconstruction with the formation of an autologous valvular voice mechanism without the use of a voice prosthesis; however, it requires a more complex abdominal stage and careful patient selection. The jejunal flap is a more versatile and less traumatic method that can be used for both primary and delayed reconstructions, while voice rehabilitation is achieved by tracheoesophageal puncture and voice prosthesis placement.

CONCLUSION: the ileocolon flapcomplex and the jejunal flap are effective methods of pharyngeal reconstruction, but they differ in their surgical capabilities and clinical indications. The choice of method should be determined by the timing of reconstruction, the patient’s somatic status, tissue condition, and the expected model of voice rehabilitation, which allows individualization of surgical strategy and improvement of functional treatment outcomes.

AIM: to evaluate the efficacy of percutaneous drainage of pericolic abscesses in the comprehensive treatment of complicated diverticular disease in patients with a high level of comorbidity.

PATIENTS AND METHODS: a treatment analysis was conducted between 2020 and 2025, involving 67 patients with diverticular disease and Hinchey stage I-II complications of various localisations. All patients (100%) had two or more comorbidities.

RESULTS: the study group underwent a total of 77 percutaneous minimally invasive interventions. In 61 patients, percutaneous drainage was performed once, which was confirmed by a recurrence-free course during the follow-up period of 1 to 5 years. For 6 patients with recurrent disease, an additional 16 percutaneous interventions were performed. Subsequently, these patients underwent elective surgery involving resection of a segment of the colon. No complications or fatal outcomes were registered. Clinical efficacy within the first three days was observed in 88% of patients, and technical success was achieved in 100% of cases.

CONCLUSION: in certain clinical situations, percutaneous drainage of diverticular abscesses is the definitive treatment option for patients with complicated diverticular disease.

AIM: to obtain data from routine clinical practice on the effectiveness of conservative treatment for patients with acute hemorrhoids, in terms of its impact on symptom severity and quality of life.

PATIENTS AND METHODS: the international, observational, prospective CHORALIS study included adult outpatients with complaints characteristic of acute hemorrhoids and who received conservative treatment in accordance with routine clinical practice. The study was conducted in 9 countries: China (n = 268), Hungary (n = 71), Kenya (n = 22), Nigeria (n = 902), Russia (n = 500), Saudi Arabia (n = 200), Senegal (n = 662), Ukraine (n = 679), and Vietnam (n = 202), allowing for data to be analyzed from multiple regions of the world. This subgroup analysis includes treatment outcomes for patients enrolled in the study in the Russian Federation (RF). Treatment efficacy was assessed based on patient assessment of acute hemorrhoid symptom reduction using a visual analog scale (VAS) and patient questionnaires using the Clinical Global Impression (PGI-C) scale and the hemorrhoid-specific quality of life questionnaire (HEMO-FISS-QoL).

RESULTS: the study in the Russian Federation included 500 patients (52.2% women), with a mean age of 41.1 ± 12.6 years. The most common symptoms were pain: 420/496 (84.6%), discomfort 477/496 (96.2%) and swelling in the anal area 352/496 (71.0%). Conservative treatment included the prescription of laxatives, topical agents and venoactive drugs: 440/499 (88.3%) received micronized purified flavonoid fraction (MPFF) preparations, and 58/499 (11.6%) diosmin. Over 4 weeks of treatment, the mean number of symptoms (IQR) decreased from 4 (3; 5) to 1 (0; 2), p < 0.001. Therapy based on venoactive drugs reduces pain intensity: initially, the median level was 5 (3.0; 7.0), and after 4 weeks — 1.2 (1.0; 2.0). The intensity of discomfort was moderate at baseline 5 (4.0; 7.2), and by the end of the observation period 1.5 (1.0; 2.0), p < 0.001 for lower symptoms. Nominally, the reduction in the number of patients with pain after 4 weeks in the MPFF group and the diosmin group was as follows: 84/438 (19.2%) and 20/57 (35.1%), respectively. The treatment provided constant self-sensitivity according to the PGI-C scale, limiting the time to improvement in 96.4% of patients, which led to satisfaction with the treatment of both the physician and the patient.

CONCLUSION: in a subgroup analysis of data from the CHORALIS study, conducted in a population of Russian patients with acute hemorrhoids, conservative therapy based on the use of venoactive drugs (mostly MPFF) was effective in reducing the symptoms of acute hemorrhoids and improving quality of life.

A few papers on bladder augmentation in patient with local advanced colon cancer are found in literature. «Gold» standard here is small intestinal augmentation. A clinical case of using stomach for this is presented.

OBJECTIVE: to analyze existing definitions of “textbook outcome” (TO) in colorectal cancer surgery and to justify the need for their standardization.

PATIENTS AND METHODS: a systematic review was conducted in accordance with the PRISMA guidelines. PubMed, the Cochrane Library, and eLIBRARY were searched for the period 2010-2025. Original studies evaluating TO in adult patients after surgical treatment for colorectal cancer were included. Study quality was assessed using the Newcastle-Ottawa scale.

RESULTS: sixteen studies (335,575 patients) were included. The rate of achieving TO ranged from 28.5% to 77.4%. Significant heterogeneity in TO definitions was identified. The most common components were R0 resection, lymph node dissection ≥ 12, absence of major complications (Clavien-Dindo ≥ III), readmissions, and mortality (30/90 days), as well as length of hospitalization (fixed values or 75th percentile). Achieving TO was associated with improved survival (a 40-55% reduction in the risk of death). Significant factors included surgical approach, ERAS, age, comorbidities, stage, neoadjuvant therapy, insurance type, and surgical volume.

CONCLUSION: TO is a valid tool for assessing the quality of surgical treatment of colorectal cancer associated with long-term survival. The lack of a unified definition limits the comparability of results. The proposed standardized definition (R0 resection, lymph node dissection ≥ 12, absence of major complications, 30-day mortality and readmissions, length of stay within the 75th percentile) can serve as the basis for international consensus.

BACKGROUND: the optimal treatment strategy for patients with rectal cancer who achieve a complete or nearcomplete clinical response after neoadjuvant chemoradiotherapy is challenging.

AIM: to assess oncological outcomes after neoadjuvant chemoradiotherapy followed by total mesorectumectomy (TME) or local excision of residual rectal tumor (TEM).

MATERIALS AND METHODS: a systematic review and meta-analysis were done according to the PRISMA 2020 guidelines. A literature search included PubMed, MEDLINE, and e-library databases until April 2025. Inclusion criteria were studies comparing long-term outcomes in patients treated with neoadjuvant chemoradiotherapy followed by surgical treatment consisting of total mesorectumectomy or local excision of residual rectal tumor. Exclusion criteria were lack of information on the study endpoints, unbalanced group sizes, preliminary results and a high risk of bias in quality of full-text articles. The primary endpoints of the study were 5-year disease-free survival (DFS) and overall survival (OS). Secondary endpoints included 1and 3-year DFS, 3-year OS, local recurrence rate and distant metastases. Generalized Kaplan-Meier curves were constructed for the meta-analysis of DFS and OS.

RESULTS: the study included 10 comparative studies (3 randomized, 1 prospective, and 6 retrospective). The incidence of local recurrence was significantly higher in the TEM group than in TME — 36/496 (7.3%) versus 22/577 (3.8%) (OR = 1.85; 95% CI: 1.05–3.25; p = 0.032). The groups were comparable in distant metastases rate — 35/420 (8.3%) cases in the TEM group and 52/498 (10.4%) in TME (OR = 0.79; 95% CI: 0.49–1.27; p = 0.326). The median follow-up was 52.5 (95% CI: 49.4–52.5) months for the TEM group and 55.2 (95% CI: 55.2–59.7) months for TME. No significant differences in DFS were found between groups (p, log-rank test = 0.39). Five-year DFS was 79.2% (95% CI: 74.8–83.9) for TEM and 80.9% (95% CI: 76.9–85.1) for TME. When analyzing the hazard ratio, no advantage of TME over TEM was proven in DFS (HR = 1.31; 95% CI: 0.93–1.85; p = 0.117). In terms of overall survival, both treatment methods were comparable (p, log-rank test = 0.43), and the 5-year OS was 88.9% (95% CI: 85.4–92.6) for TEM and 87.6% (95% CI: 84.1–91.2) for TME. Hazard ratio analysis revealed no statistically significant differences (HR = 1.11; 95% CI: 0.70–1.71; p = 0.656).

CONCLUSION: TEM is comparable to TME in oncological outcomes of patients with complete or near-complete clinical response after neoadjuvant chemoradiotherapy. However, selection criteria for this group of patients should be taken into account, such as the presence of a near-complete clinical response, small residual tumor size, affected mesorectal lymph nodes, and a tumor regression grade mrTRG 0-1.

Surgical treatment of complex forms of anal fistulas is associated with the formation of extensive perineal wounds, which are characterized by a long healing period, which increases the rehabilitation time of patients. The article discusses physical, chemical, surgical, and biological methods for stimulating wound regeneration and the possibilities of their use for the treatment of extensive perineal wounds. Currently, the use of stem cells is a promising direction in the treatment of common perineal wounds. An analysis of existing scientific papers indicates the safety and high efficiency of autologous adipose tissue components and a wide range of stem cell effects on healing processes in many fields of medicine. However, data on the use of MSCs in coloproctology are very limited, and their place remains not fully understood.

AIM: to systematically analyze key methodological challenges encountered when comparing surgical strategies for patients with rectal cancer (RC) and isolated synchronous resectable liver metastases.

PATIENTS AND METHODS: a literature search was performed in PubMed/MEDLINE, Cochrane Library, Web of Science, Scopus, and Elibrary (2000–2026). Studies comparing two or more surgical strategies (simultaneous, rectum-first, liver-first) for RC with synchronous liver metastases, methodological articles, RCTs, prospective and retrospective cohort studies, meta-analyses were included. Studies on colon cancer without separate analysis, metachronous or unresectable metastases, and case series with n < 10 were excluded.

RESULTS: major methodological limitations were identified: selection bias (patients with different disease burden allocated to different strategies); immortal time bias in staged approaches; asymmetric comparison of complications (one surgery vs. two surgeries); heterogeneity of systemic and radiation therapy regimens; incomplete treatment (up to 35% in liver-first); mixing of colon and rectal cancer populations; limitations of propensity score methods; lack of large RCTs. Proposed solutions include pragmatic and registry-based RCTs, target trial emulation (TTE), stratification by liver resection volume, neoadjuvant therapy regimen, molecular profile, and adherence to reporting guidelines (STROBE, TARGET).

CONCLUSION: existing methodological problems substantially limit data interpretation. Definitive conclusions

Anal sphincter insufficiency is a multifactorial clinical syndrome associated with impaired bowel control and a marked reduction in quality of life. Despite substantial etiological differences between adults and children, the clinical presentation in both age groups is determined by a mismatch between the anatomical substrate and the functional reserve of the continence mechanism. In adults, acquired forms predominate and are mainly related to obstetric injury, consequences of anorectal surgery, and neuromuscular or degenerative disorders. In children, the major causes include anorectal malformations, sequelae of their surgical correction, and functional defecation disorders. This review summarizes current concepts of continence mechanisms, etiological and pathogenetic factors, diagnostic principles, and treatment strategies for anal sphincter insufficiency in adults and children. Particular attention is paid to anatomic-functional stratification as a unifying principle for adult and pediatric practice, allowing differentiation between clinical settings in which a correctable anatomical defect is the leading factor and those in which functional disturbances predominate. Contemporary treatment in adults includes stepwise use of conservative therapy, rehabilitation, sphincteroplasty in selected patients, and sacral neuromodulation. In pediatric practice, the key priorities are exclusion of postoperative anatomical defects, assessment of continence development potential, bowel management programs, and staged rehabilitation. Rehabilitation is considered an essential component of treatment in both age groups: in adults, as a tool for restoring and optimizing preserved function, and in children, as a means of forming a controlled defecation pattern and achieving social continence.