AIM: to demonstrate the first experience of using the platform for transanal endoscopic microsurgery treatment for fistula of the colorectal anastomosis.PATIENTS AND METHODS: from October 2017 to March 2023 5 patients (36-77 years old) with persistent fistula of the colorectal anastomosis were included in the cohort. All of them underwent rectal resection for cancer. The surgery technique was presented on clinical case with defect of colorectal anastomosis on the posterior side up to 0.5 cm length with presacral sinus up to 2.5 cm in the largest dimension.RESULTS: no postoperative morbidity developed. Patient discharged on the 6th day. CONCLUSION: TEM platform allows to consider it promising approach for the persistent fistula of colorectal anastomosis.

AIM: to assess the relationship between clinical features and diagnostic tests results in idiopathic megacolon/megarectum patients.PATIENTS AND METHODS: the retrospective analysis of clinical manifestations and diagnostic tests included 157 patients with idiopathic megacolon/megarectum in 2002-2023. The diagnosis of megacolon/megarectum was verified with a barium enema, Hirschsprung’s disease was excluded byanorectal manometry and (if needed) rectal Swenson’s biopsy.RESULTS: the rate of integral parameter “abdominal discomfort” and Wexner constipation scale rate do not significantly correlate with barium enema, gut transit test, defecography and rectal compliance test results, besides of sigmoid colon width (p = 0.03). The rate of integral parameters “defecation difficulties” correlates with rectum width (p < 0.001) and do not correlate with gut transit time, results of defecography and rectal compliance test (p > 0.05). Distal contrast retention during gut transit test is associated with rectum width only (p < 0.01). The parameters of defecography do not correlate neither clinical features nor other diagnostic tests results (p > 0.05).CONCLUSION: there was not significant relationship between rate of abdominal discomfort, Wexner constipation scale rate and diagnostic tests results. The rate of integral parameters “defecation difficulties” significantly correlates with rectum width (based on barium enema) only. Rectum width seems to be most important parameter to assess the rectum function and in a minor degree — rectal compliance test. The defecography do not correlate either with the severity of clinical symptoms or with the results of other diagnostic methods, which casts doubt on the appropriateness of using this diagnostic test in patients with megacolon.

AIM: to evaluate the early results ileocecal resection with extended lymphadenectomy in patients with localized cecal cancer.PATIENTS AND METHODS: from December 2021 until June 2023 40 patients with verified malignant cecal tumors were included in the study. The patients were divided into two groups: 20 patients underwent ileocecal resection with extended lymphadenectomy in the D3 volume; the control group included 20 right hemicolectomies with D3 lymphadenectomy.RESULTS: no postoperative mortality. The differences were revealed in the course of the intraoperative and early postoperative period, the volume of the removed mesentery and the length of the resected section of the intestine, and the number of removed lymph nodes. Metastasis to lymph nodes was detected at the level of 201 and 202 groups.CONCLUSION: ileocecal resection with extended D3 lymphadenectomy is an effective and safe method for localized forms of cecal cancer and can be considered as an alternative to the standard right hemicolectomy.

AIM: to estimate the effectiveness of a medical decision support system based on artificial intelligence in the endoscopic diagnosis of benign tumors during tandem study.PATIENTS AND METHODS: from October to December 2023, a single-center comparative tandem study of medical decision support system based on artificial intelligence “ArtInCol” was done. The first stage was a traditional colonoscopy under sedation, the second one — colonoscopy using AI. A pairwise comparison of the main indicators of the effectiveness was made.RESULTS: in the primary endpoint, the polyp detection rate (PDR) in the traditional colonoscopy group was 40.6% vs 56.4% in the AI group, p = 0.0001 (RR = 1.39; 95% CI: 1.04–1.87). The mean number of lesions detected (MPP) was 1.63 (± 1.2) vs 2.47 (± 1.8) in the AI group (mean difference = 0.84; (95% CI: 1.07–0.61).CONCLUSION: the study demonstrated the effectiveness of the original medical decision support system for benign colon tumors detection in real clinical practice. The further stage, a multicenter randomized trial is needed.

AIM: to compare the hernia rate and the post-operative morbidity in patients after retroperitoneal and traditional (direct) colostomy during laparoscopic APR.PATIENTS AND METHODS: the retrospective study included patients with rectal and anal cancer after laparoscopic APE in 2019-2022. Direct or retroperitoneal end colostomy were the surgeon’s choice. Primary endpoints were the hernia rate after ≥ 1 year by abdominal CT and post-operative morbidity (Clavien-Dindo).RESULTS: fifty patients were included in the study (30 patients with retroperitoneal colostomy and 20 patients with direct colostomy). There were no significant differences in parameters that could affect the results. Four (13.3%) vs 8 (40%) patients developed parastomal hernias in the retroperitoneal and direct colostomy group, accordingly (p = 0.045). No post-operative morbidity grade 4–5 and no other complications that could be attributed to retroperitoneal colostomy occurred. Post-operative morbidity grade 3 developed in 3 (10%) patients in the retroperitoneal colostomy group and in 1 (5%) — in the direct one (p = 0.64).CONCLUSION: retroperitoneal colostomy in laparoscopic APE may reduce the parastomal hernia rate. It is important to conduct prospective comparative studies.

AIM: to assess original method of hemorrhoidectomy with lateral ultrasonic dissection in cutting mode in patients with stages 3–4 hemorrhoids.PATIENTS AND METHODS: a retrospective study included 140 patients with hemorrhoids 2–4 stages. In the main group (n = 80), an original technique of lateral ultrasound dissection in cutting mode was used (patent for invention No. 2722997). Patients in the control group (n = 60) underwent Milligan-Morgan hemorrhoidectomy using electrosurgical scalpel.RESULTS: significant differences were achieved in intensity of pain syndrome, morbidity rate, which were significantly in the main group. Histology showed that the depth of coagulative necrosis when in the original technique was 145 ± 25 µm vs 1730 ± 180 µm in the controls (р < 0,001). Anorectal manometry data, significantly less dysfunction anal sphincter was noted in the postoperative period in the main group.CONCLUSION: hemorrhoidectomy with lateral ultrasonic dissection in cutting mode reduces tissue trauma, morbidity rate and intensity of pain, and also promotes rapid restoration of anal continence.

AIM: to compare the diagnostic informativeness of mucosal dye spraying (chromoendoscopy) (CE) and virtual chromoendoscopy (VCE) in detecting dysplasia in patients with a long history ulcerative colitis (UC).MATERIALS AND METHODS: a systematic review and meta-analysis of studies comparing the results of the use of CE and VCE for the diagnosis of colitis-associated dysplasia was performed. The following indicators were evaluated: the frequency of patients with endoscopically detected colitis-associated dysplasia and the frequency of endoscopic diagnosis of colitis-associated dysplasia among the total number of identified lesions. The statistical analysis was carried out using the Review Manager software 5.3RESULTS: the systematic review included 4 studies, analyzing 364 patients in total. In the study groups, there were no statistical differences in patients with endoscopically detected colitis-associated dysplasia and in endoscopic diagnosis of colitis-associated dysplasia among total number of detected colorectal neoplasms (OR = 0.87; 95% CI 0.60–1.27; p = 0.47 and OR = 0.82; 95% CI 0.58–1.18; p = 0.29).CONCLUSION: meta-analysis could not demonstrate a significant difference between CE and VCE. However, additional studies are needed to recognize the role of VCE in the differentiation of neoplastic and non-neoplastic lesions in patients with UC

AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

AIM: to assess the effectiveness of proton radiotherapy as part of a combined approach to the treatment of rectal malignancies and to assess acute radiation toxicity, which directly affects patients’ quality of life.PATIENTS AND METHODS: between 2020 and 2023, a study included 74 patients with rectal cancer. The mean age of the patients was 65 ± 9.9 years, 44 (60%) males. Stage I occurred in 8 (10.8%) patients, stage II — in 14 (18.9%) patients, stage III — in 52 (70.3%) patients. At the first stage, all patients completed proton radiation therapy in the classical fractionation mode.RESULTS: of the adverse events, 49 (66%) patients had grade 1–2 radiation reactions in the form of proctitis and cystitis. There were no local radiation reactions of grade 3 or higher. Systemic complications of grade 3 were noted in 2 (2%) patients in the form of hematological toxicity — anemia (1%), afebrile neutropenia (2%). Of the 62 operated patients, 12 (19.3%) people showed complete therapeutic pathomorphosis. With a median follow-up of 23 months (13;35), 1 (1.35%) patient showed continued tumor growth 28 months after completed radiotherapy, 2 (2.7%) patients had local recurrence 3 and 18 months after treatment. Distant metastases to the lungs, liver, or bones were detected in 9 (12.2%) patients, median — 12 months (6;23). Mortality during the entire observation period was 9 (12.2%) patients. Sixty-two (83.8%) patients showed no signs of relapse or progression of the disease, of which 9 (14.5%) patients did not receive any treatment after chemoradiotherapy and are in the process of active follow-up.CONCLUSION: proton radiation therapy in patients with rectal cancer in two-year overall survival (90.5%) and progression-free survival (88.9%) are comparable with the literature data of recent studies, but are superior in overall survival pathological response (19.3%).