AIM: to evaluate the early results of selective lateral pelvic lymph node dissection (LPLD) in patients with middle and low rectal cancer after neoadjuvant CRT with suspected lateral lymph nodes (LLN) involvement based on MRI data.

PATIENTS AND METHODS: a prospective single-arm single-center study included 70 patients with a verified diagnosis of rectal cancer (mrT1–4N1–2сM0–1) who underwent total mesorectal excision (TME) with LTLD after neoadjuvant chemotherapy between January 2023 and May 2025. Intraoperatively, all patients underwent fluorescent navigation with indocyanine green and LLN ultrasound. The primary endpoint was the presence of metastases in the LLN based on histology. Secondary endpoints included: sensitivity and specificity of MRI in detecting LLN metastases, postoperative morbidity, local recurrence rate, operation time, blood loss, hospital stay, and the relationship between LLN size and the presence of metastases.

RESULTS: in 23/70 (33%) patients, metastatic involvement of the LLN was confirmed. The sensitivity and specificity of MRI were 91% (95% CI: 72.0%–98.9%) and 38% (95% CI: 24.5%–53.6%). A comparison of the median short axis in patients with metastatic LLN involvement (9.2 (7.8; 11.3) mm) and in patients without metastasis (5.4 (4.2; 6.5) mm) revealed a significant difference (p < 0.001). The operation time was 210 (170; 265) minutes, and total blood loss was 60 (30; 120) ml. Clavien–Dindo grade I-II complications detected in 16/70 (23%) patients. No cases required re-operation. The hospital stay was 12 (10; 16) days. Local recurrences revealed in 3/70 (4%) patients with follow-up of 14 (8; 20) months.

CONCLUSION: selective LPLD after neoadjuvant HLT is a potentially effective method for reducing the risk of local recurrence in patients with suspected LLN involvement in rectal cancer. However, randomised controlled trials with a long follow-up period are needed to definitively assess its contribution to improving late outcomes.

AIM: to compare the clinical features and quality of life estimation in patients with chronic constipation due to idiopathic megacolon/megarectum and slow-transit constipation.

PATIENTS AND METHODS: the comparative retrospective analysis (2003-2024) had been provided in 260 patients with chronic constipation, which were undergone barium enema to exclude/confirm megacolon/megarectum. 1 group (n=158) consisted of patients with idiopathic megacolon/megarectum. Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. 102 patients with chronic slow-transit constipation and normal size of the bowel were included in 2 group.

RESULTS: In 1 group patients were statistically significant younger (Me=26.0 (19.0; 43.0) years and Me=33.0 (23.0; 48.0) years (p=0.043)) and significant male predominance were observed (87/158 (55.1%) vs 15/102 (14.7%), (p<0.0001)). Wexner constipation scale rate, burden of symptoms of  abdominal discomfort and defecation difficulties in point scale were significant higher in 2 group patients with normal size of bowel (p=0.01, p=0.013 and p=0.0005, respectively). Summary assessment of quality of life with an IBSQOL questionnaire were significant better in 1 group (p=0.0001). At the same time there were no significant difference in overall transit time between groups (p=0.789). Defecation impairment assessed by defecography (time of defecation and rest volume) were significant more in 1 group (p<0.0001 for both). In multivariate analysis (General regression models),taking into account age and gender of patients, the presence of megacolon/megarectum was significant independent predictor of better quality of life, as the young age too ((p=0,001 и p=0,013, respectively). In addition, contrary to defecography results, there was significant association between the presence of megacolon/megarectum and lower rate of “defecation difficulties” scale (p=0,002). At the same time female gender was only significant independent predictor of burden of Wexner constipation scale and “abdominal discomfort” scale (p=0.0007 и p=0.048, respectively).

CONCLUSION: patients with chronic constipation due to idiopathic megacolon/megarectum have significant better quality of life and lower burden of clinical features then slow-transit constipation ones.

AIM: to identify risk factors affecting the anal incontinence (AI) in Crohn’s disease. P

ATIENTS AND METHODS: a retrospective study included 191 patients with perianal fistulizing Crohn’s disease in February 2017 — September 2024. Sphincter function was assessed via Wexner’s scale and sphincterometry. The incontinence symptoms were revealed in 118/155 (76%) patients. AI according sphincterometry was fixed in 175/191 (90%) cases. Associations were examined between: clinical/ anamnestic parameters, incontinence symptoms, anal sphincter insufficiency (sphincterometry -confirmed), and risk factor effects on sphincter tone/voluntary contraction.

RESULTS: previous anal surgery, regardless of the number of operations, increases the likelihood of AI confirmed by sphincterometry (odds ratio (OR) = 4.1; 95% confidence interval (CI): 1.27–13.2; p = 0.02). When analyzing individual sphincterometry data, the effect of the duration of the perianal disease (OR = 1.11; 95% CI: 1–1.22; p = 0.04) and the number of fistula-related abscesses (OR = 1.49; 95% CI: 1.13–1.97; p = 0.005) on the reduction of maximum anal squeeze pressure was revealed. According to data obtained, the risk of a decrease in the maximum anal squeeze pressure increased in patients with chronic perianal lesions for more than 5.5 years (OR = 2.74; 95% CI:1.24–6.06, p = 0.012), as well as in patients with 2 or more actively draining collections (OR = 2.36; 95% CI:1.39–4.31, p = 0.005).

CONCLUSION: analysis of predictors for anal incontinence in patients with Crohn’s disease-related perianal lesions will help develop optimal treatment strategy for these patients, thus highlighting the need for further research in this area.

AIM: to identify predictors of ER after 12 months of therapy in patients with mild-to-moderate UC based on clinical, laboratory, endoscopic, and histopathological parameters.

PATIENTS AND METHODS: this prospective study enrolled patients with mild-to-moderate UC after excluding intestinal infections. Clinical, laboratory, endoscopic, and histological parameters were assessed at baseline and during follow-up. Early predictors of ER within 12 months were identified, and a predictive regression model was developed.

RESULTS: longitudinal follow-up of 72 patients revealed that unfavorable predictors of ER at 12 months included: excess body weight - observed in 9.1% of patients who achieved ER versus 41.0% of non-responders (adjusted odds ratio (aOR) 0.026; 95% confidence interval (CI): 0.002-0.374; p=0.007), and pancolitis - 23.3% versus 45.2% (aOR 0.076; 95% CI: 0.013-0.445; p=0.004). The protective factor was absence of fever at baseline (43.1% in ER group vs 7.1% in non-ER group; aOR 17.49; 95% CI: 1.203-254.206; p=0.036). Moderate endoscopic activity at inclusion showed no significant association with outcomes (p=0.077). The developed model (p<0.001) demonstrated an AUC of 0.800±0.052 (95% CI: 0.699–0.901), with 90.9% sensitivity, 82.6% specificity, and 80.6% overall accuracy.

CONCLUSION: excess body weight and pancolitis at baseline were negative prognostic markers for achieving ER at 12 months, whereas the absence of fever at baseline increased the likelihood of this outcome. However, endoscopic activity did not show a statistically significant impact in the multivariate analysis. The model exhibits high sensitivity and moderate specificity, suggesting its potential utility as a supplementary predictive tool in clinical practice following validation.

AIM: to assess the effect of laser therapy on wounds healing after open hemorrhoidectomy.

PATIENTS AND METHODS: a single-centre, prospective, randomised study included 86 patients who underwent open hemorrhoidectomy using an ultrasound scalpel. In addition to the standard use of water-based ointments daily from days 1 to 7 after surgery and then once a week until the wounds were fully healed, laser treatment was performed on the wounds in patients in the main group (n = 46). Patients in the control group (n = 40) received only standard therapy (water-based ointments). Laser treatment was performed using a fibre laser with a wavelength of 970 nm in a non-contact manner with a defocused beam. The beam power was 20 W, the power density was 0.038 W/cm² and the mode was pulsed-periodic (impulse duration 50 ms, pause 100 ms). Each session lasted 4 minutes. Pain intensity was assessed with visual analogue scale (VAS). The rate of wound epithelialisation on the 30th day after and QoL using the SF-36 questionnaire. The microbiome of surgical wounds at various stages of treatment, a microbiological study was studied as well.

RESULTS: on the 30th day after surgery, planimetric and cytological characteristics of wounds corresponded to complete epithelization in 42/46 (91%) patients of the main group and in 7/40 (18%) controls, p < 0,001. The pain intensity in the main group already from the 2nd day after surgery was 4 (4; 6) points and was significantly lower than in the control group — 6 (5; 7) points, p < 0,001. When comparing the patients’ quality of life indicators by SF-36 questionnaire on the 30th day after surgery, significant differences were revealed: physical functioning (PF) — 85 (75; 95) points in the main group, 80 (70; 85) — in the control group (p = 0.030); pain intensity (BP): 51 (41; 64) in the main group, vs 41 (22; 51) in the control, (p = 0.008); and role functioning conditioned by emotional state (RE) — 100 (66; 100) points vs 66 (17; 67), (p = 0.002). Microbiology showed that laser therapy already on the 7th day contributes to a significant reduction of postoperative wound infestation in the patients of the main group compared to the control group, and on the 21st day the difference becomes statistically significant — positive growth was noted in 23/42 (54.8%) patients of the main group and in 38/40 (95.0%) of the control group, p < 0.0001.

CONCLUSION: the use of laser therapy for wounds after open hemorrhoidectomy allows to achieve good clinical results in healing time, decreased intensity of pain syndrome, decreased bacterial contamination of wounds, which, in turn, contributes to the improvement of the quality of life of operated patients and shortening of rehabilitation.

OBJECTIVE: to develop and validate a novel method for diagnosing colorectal cancer (CRC) by semi-quantitative analysis of specific populations of plasma small extracellular nanovesicles (SEVs) using AuNP-aptasensor technology.

MATERIALS AND METHODS: the study used plasma samples from patients with colorectal cancer (n = 37), patients with Crohn’s disease (n = 10), and healthy donors (n = 32). Investigation of standard SEVs characteristics was performed using nanoparticle tracking analysis (NTA) and flow cytometry; gold nanoparticle characteristics were analyzed using dynamic light scattering (DLS) and absorption spectroscopy. Semi-quantitative analysis of specific SEVs populations was performed using AuNP-aptasensor technology, employing a colorimetric method for result evaluation.

RESULTS: AuNP-aptasensors based on nine different DNA aptamers were developed and tested. An increase in the number of CRC-specific SEVs in the plasma of patients with CRC was shown compared to the plasma of donors and patients with Crohn’s disease. Optimized AuNP-aptasensor revealed following indicatirs of diagnostic significance: AUC — 0,95, specificity — 88,89%, sensitivity — 90,63%.In the group of patients with CRC, the correlation between tumor size and the results obtained using the AuNP-aptasensor was evaluated

CONCLUSION: assessing the quantity of CRC-specific plasma SEVs using AuNP-aptasensor technology is a promising method for diagnosing CRC.

BACKGROUND: Advances in colorectal surgery include energy devices for precise dissection and hemostasis. This observational study evaluates the ultrasonic scalpel and electrocautery in colorectal surgeries, analyzing intra- and postoperative parameters to inform decisions and best practices.

METHODS: Prospective observational study at a tertiary center (12/19/2022–09/30/2024). Data collected and analyzed with SPSS 23.

RESULTS: Comparable groups in baseline characteristics. There were no significant differences in operative time, intraoperative bleeding, postoperative drainage (48h), or hospital stay between the ultrasonic scalpel and electrocautery.

CONCLUSION: The ultrasonic scalpel and electrocautery are valuable tools for dissection and hemostasis in colorectal surgery, crucial for effective and safe minimally invasive approaches. Long-term effects should be determined. Study approved (IEC2:474/2022) and registered (CTRI/2022/12/048254).

A 74-year-old female patient underwent endoscopic treatment for chronic radiation proctitis. We successfully performed endoscopic radiofrequency ablation. The intervention performed allowed not only to improve the patient’s quality of life, but also to avoid high volume surgery.

AIM: to evaluate  the performance of artificial-intelligence algorithms in predicting long-term treatment outcomes in patients with colorectal cancer using clinical data alone to evaluate the performance of artificial-intelligence algorithms in predicting long-term treatment outcomes in patients with colorectal cancer (CRC) using clinical data alone.

MATERIALS AND METHODS: a systematic search (2015–2024) was conducted in PubMed, Science Direct, MedRxiv, BioRxiv and Google Scholar. Original studies that applied machine-learning or deep-learning techniques exclusively to clinical variables for predicting CRC recurrence were included. Of 657106 records screened, 43 met the eligibility criteria; 12 were entered into a meta-analysis. Pooled area under the ROC curve (AUC), heterogeneity metrics (I², τ², Q-test), publication bias and sensitivity were assessed. Robustness was examined with a leave-one-out analysis.

RESULTS: a systematic search (2015–2024) in PubMed, Science Direct, MedRxiv, BioRxiv and Google Scholar. Original studies that applied machine-learning or deep-learning techniques exclusively to clinical variables for predicting CRC recurrence were included. Of 657106 records screened, 43 met the eligibility criteria; 12 were entered into a meta-analysis. Pooled area under the ROC curve (AUC), heterogeneity metrics (I², τ², Q-test), publication bias and sensitivity were assessed. Robustness was examined with a leave-one-out analysis.

CONCLUSION: AI models show promising accuracy in predicting colorectal cancer recurrence, supporting their potential utility in clinical decision-making. Nevertheless, further validation in large-scale, prospective studies is required before widespread clinical implementation.

AIM: to compare the efficacy (wound healing) and safety (wound infection) between traditional treatment after open access for pilonidal sinus (PS) and with use of platelet-rich plasma (PRP).

MATERIAL AND METHODS: a systematic review and meta-analysis of clinical research data was conducted to compare lay — open method with the use of PRP and lay — open method without the use of PRP for the treatment of PS. The meta-analysis included 4 randomized clinical trials and obtained data on the results of treatment of 299 patients. However, almost all the publications show a high risk of bias in their results.

RESULTS: the meta-analysis revealed a statistically significant revealed of lay — open method with the use of PRP in reducing wound area on days 10 (MD = 3.68, 95% СI: 3.29–4,06, p < 0.00001), 15 (MD = 5.73, 95% СI: 2.94–8.53, p < 0.00001) and 20 (MD = 6.62, 95% СI: 6.14–7.10, p < 0,00001) after surgery, as well as reducing wound healing time (MD = 19.01, 95% CI: 6.40–31.63, p < 0.000001) and pain duration (MD = 10.46, 95% СI: 2.20–18.72, p < 0.00001), and a shorter period of return to work (MD = 12.80, 95% CI: 3.62–21.98, p < 0,00001) compared with the lay — open method without the use of PRP for the treatment of PS. There was no significant difference in the incidence of wound infection between the two comparison groups (MD = 3.92, 95% CI: 1.01–15.22, p = 0.05).

CONCLUSION: topical application of PRP in combination with pilonidal sinus excision followed by open wound management represents an effective and safe treatment approach for chronic inflammation in pilonidal sinus disease. Due to the high heterogeneity of the analyzed data, as well as the poor quality of studies included in meta-analyses, it is essential to treat results with caution. Further randomized controlled trials are needed to avoid incorrect conclusions.

AIM: to compare the incidence of early and late postoperative complications after creation and closure of preventive loop ileostomy or colostomy, and to determine whether one type of intestinal stoma is safer than the other when creating a low colorectal anastomosis.

MATERIALS AND METHODS: the search for scientific papers was conducted in the electronic databases of medical literature PubMed and Elibrary for the past 30 years using the keywords: ileostomy, colostomy; loop ileostomy, loop colostomy; temporary stoma; complications. A systematic review and meta-analysis were conducted, which included 5 randomized and 15 comparative non-randomized studies in English and Russian, which reflected the nature of complications arising from the use and elimination of ileostomies and colostomies. Complications were divided depending on the nature and time of occurrence into early and late. Early complications included: stoma necrosis, stoma bleeding, peristomal dermatitis, stoma retraction, dehydration and parastomal abscess. Late complications included: stoma stricture, stoma prolapse, colorectal anastomotic failure and parastomal hernia. Complications associated with reconstructive surgery with stoma elimination were also analyzed: postoperative hernia in the stoma area, wound infection and hematoma of the anterior abdominal wall, intestinal obstruction. The meta-analysis was performed in accordance with the practice and PRISMA recommendations.

RESULTS: when examining comparative non-randomized studies, it was found that patients with colostomy significantly more often developed late complications such as stoma stricture (odds ratio (OR) = 3.86; 95% Confidence interval (CI): 1.27–11.72; p = 0.02) and stoma prolapse (OR = 2.91; 95% CI: 1.49–5.72; p = 0.002), as well as an early complication in the form of stoma retraction (OR = 2.53; 95% CI: 1.54–4.16; p = 0.0002). Whereas the formation of ileostomy is associated with a higher risk of dehydration (OR = 0.23; 95% CI: 0.12–0.45; p < 0.00001). In contrast, in an analysis of randomized clinical trials (RCTs), the incidence of complications such as stoma prolapse (OR = 8.87; 95% CI: 2.53–31.12; p = 0.0007) and dehydration (OR = 0.32; 95% CI: 0.03–3.14; p = 0.33) were comparable between patients with colostomy and ileostomy. Information on stoma retraction was provided in only one RCT, while stoma stricture was not mentioned at all. In both randomized (OR = 1.19; 95% CI: 0.52–2.75; p = 0.68) and comparative non-randomized studies (OR = 0.56; 95% CI: 0.31–1.02; p = 0.06), the incidence of peristomal dermatitis was slightly higher in patients with ileostomy, but statistical significance was not achieved. The incidence of stoma necrosis, stoma bleeding, parastomal abscess, and parastomal hernia did not differ in both groups. According to the data obtained, complications after reconstructive surgeries associated with the elimination of intestinal stoma are not typical for any of the patient groups.

CONCLUSION: the choice of a preventive stoma is still a subject of debate and discussion. Ileostomy is associated only with a higher risk of dehydration. However, the formation of a loop colostomy is accompanied by a significantly higher incidence of prolapse, retraction and stricture of the stoma, all other complications were comparable. Further randomized clinical trials are needed to confirm the reliability of these differences.

INTRODUCTION: various surgical techniques are used in rectal fistula treatment however all of them can negatively effect on anal sphincter. One of the most serious complications is the development of postoperative insufficiency of the anal sphincter. The introduction of various bioplastic materials significantly influences on the development of low-traumatic operations.

AIM: to evaluate the effectiveness of fibrin glue and bioplastic implants usage in treatment of rectal fistulas.

PATIENTS AND METHODS: literature background was searched in several databases: PubMed, eLibrary and Kohrane. 842 articles on bioplastic implants and fibrin glue were found. The articles were selected according to the following criteria: the structure, consistency, relevance and evidence (the presence of supporting links to original research) of the text, information about the author’s publications’ subjects, the number of citations of the articles. The exclusion criteria were fistulas associated with inflammatory bowel diseases, post-traumatic and post-radiation ones. After analyzing the text 20 articles were selected: 19 of them in English and 1 article in Russian in the period from 2009 to 2023.

CONCLUSION: the methods presented in this review do not aggravate the muscle functional indicators of the anal sphincter; however they show high percentage of disease recurrence. Considering the safety of the techniques, they can be used as the first line of treatment for rectal fistulas. However, it is necessary to study the risk factors of fistula recurrence and to modify the methods according to them.

Diagnostics and treatment of early colorectal cancer with submucosal invasion (T1 CRC) is a relevant and complex problem of modern oncology. Advancements in endoscopic techniques allows for organ-preserving treatment with local removal of the tumor with submucosal invasion. The main problem in organ preservation treatment of T1 CRC is patient selection and the most accurate assessment of the risk of tumor metastasis in each personal history. Currently, morphological characteristics of the tumor are the main predictors of metastasis in T1 CRC. However, the use of recommended morphological predictors has identified certain problems in the selection of patients with an overestimation of indications for additional surgical treatment.

Among the lesions of the perineum in women, pelvic organ prolapse occupies a prominent place. One of its variants is rectocele — protrusion of the rectum wall together with the posterior vaginal wall (PVW) towards the vagina (anterior rectocele) and/or along the posterior semicircle of the intestine (posterior rectocele). Anterior rectocele (AR) is accompanied by obstructive bowel movement syndrome (OBMS) with symptoms such as pain, constipation and the need to use a finger aid during defecation. The prevalence of pelvic organ prolapse (POP) among women in some countries reaches 50%. In Russia, this figure exceeds 30%. Women of reproductive age (RA) in the context of POP and AR are of particular interest. The disease in this group is asymptomatic for a long time. A risk factor for POP in RA-women is vaginal delivery without physical rehabilitation, especially with a large fetus. An analysis of the literature indicates that operations on the posterior wall of the vagina, regardless of the technique, improve the structure of the posterior wall with a high frequency and reduce the frequency of symptomatic manifestations of AR with a lower frequency. The effectiveness of implantation of biological or synthetic grafts is not higher, and the number of potential complications, including dyspareunia and erosion of the synthetic implant, is higher. Stapler transanal resection of the rectum is associated with an improvement in the anatomy of the PVW and the resolution of OBMS after intervention. To date, there are about 300 different surgical techniques for the treatment of AR. In 2020, a working group of the International Federation of Obstetricians and Gynecologists (FIGO), analyzing the available data on the treatment of AR, concluded that a tactic involving traditional (with implication of the rectovaginal fascia) posterior colporraphy with native tissues without the use of synthetic implants is preferable. However, there is not enough data to determine the reference method of surgical treatment of AR, and the issue requires further study.

The literature review highlights modern approaches to the diagnosis and choice of treatment for acute diverticulitis of the colon. The significance and effectiveness of clinical laboratory and imaging research methods are considered. Ultrasound and computed tomography are currently the most accurate diagnostic methods for acute diverticulitis, with a sensitivity of 85–97% and a specificity of 90–99%. Special attention is paid to surgical tactics in complicated diverticulitis, the role and place of percutaneous interventions, various options for colon resection, including laparoscopic access.

AIM: to analyze the published data on the diagnosis of diverticular bleeding and to justify the choice of effective approach for the clinical checkup of these patients.

MATERIALS AND METHODS: a systematic literature search was carried out on electronic data bases Library.ru, PubMed and Cochrane Library 2005–2025. To collect the published data, search queries were used — colonic bleeding OR colonic diverticular bleeding AND colonoscopy AND contrast-enhanced computed tomography AND arteriography AND transabdominal ultrasound AND technetium-99m-tagged red blood cell scanning. Initially, 832 publications were found. After screening and evaluating the abstracts, followed by a study of the full texts of the papers, 66 articles were selected, including 4 meta-analyses, 5 reviews, 34 clinical trials, and 5 clinical recommendations. This article has been prepared in accordance with PRISMA standards.

RESULTS: over the past 20 years, the rate of large intestinal diverticular bleeding has increased significantly in the structure of gastrointestinal bleeding. Recently, early colonoscopy using standard solutions for oral lavage, an endoscopic cap, and a water jet irrigator are recommended as the main method of diagnostics. Contrast-enhanced computed tomography can be chosen as the initial diagnostic method of examination in cases where high-quality emergency colonoscopy cannot be performed, as well as when endoscopic hemostasis is ineffective, when the possible use of transcatheter arterial embolization or surgical intervention is being discussed. The use of selective angiography is justified in case of ongoing massive or prolonged recurrent diverticular intestinal bleeding, when colonoscopy fails to determine the bleeding site.

CONCLUSION: a personalized choice of a diagnostic program for intestinal bleeding should be based on an objective assessment of the severity of the patient’s condition, the use of modern endoscopic and radiation imaging options to identify the causes of bleeding, establish the exact location of the source and perform the necessary high-tech treatment in a multidisciplinary hospital.