Anastomosis Formation Research Articles

Degree of leukochimerism with calf age in Angus-crossbred twin sets.

Twinning in cattle is infrequent and usually undesired. It can result in an increased occurrence of abortion and dystocia, reduced calf survival and a high likelihood of freemartinism in mixed-sex twins. Twin gestations are also commonly associated with the formation of placental vascular anastomoses (PVA) between twins. Through PVA they share blood, hormones (leading to freemartinism in mixed sex twins) and hematopoietic stem cells, which are the progenitors of white blood cells. The sharing of stem cells between twins can result in leukochimeric twin sets. These are twins that have white blood cells derived from both self and the co-twin owing to the fetal migration of hematopoietic stem cells from the extraembryonic mesoderm of the yolk sac to final sites like bone marrow and thymus. This study examined the degree to which this leukochimerism changes with age. DNA was extracted from hair bulbs containing mesenchymal dermal papilla to determine the individual's true genotype and blood samples were obtained at six time points from 1 week to 8 months of age to assess leukochimerism. Samples were genotyped using a medium density SNP chip, and quantitative estimates of allele frequency were determined using SNPs for which members of a twin set had alternative homozygous genotypes. The results indicate statistically significant changes in the proportion of self and co-twin with age and suggest that by 2-4 months of age the genotypic mix in white blood cells represents the hematopoetic stem cell population resident in the individual (i.e. permanently found in thymus and bone marrow).

Laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra

Introduction. The most common treatment option for prostate cancer is radical prostatectomy, which involves the removal of the prostate itself and the prostatic urethra in a single block, followed by the formation of a vesicourethral anastomosis. This approach is fraught with postoperative complications, such as urinary incontinence and strictures of anastomosis. In this sense, the clinic's staff faced the question of the possibility of a urethral-sparing variant of operative benefit for a certain category of patients.Objective. To assess the possibility of performing radical prostatectomy with sparing of the proximal prostatic urethra in the laparoscopic version, its advantages, and disadvantages.Materials & methods. From 2021 to 2022, 18 successful laparoscopic operations were performed using this technique at the St. Luke Clinical Multidisciplinary Medical Centre. Patients were selected according to the above criteria. In the preoperative period, patients underwent a standard examination in accordance with guidelines, including a blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D-modelling, data from a multifocal prostate biopsy, the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF), the Quality of Life (QoL) index due to urinary disorders, assessment by the Partin’s nomogram. Intraoperative ratios, early and late postoperative complications, length of hospital stay, day of catheter removal, and time to complete urethral recovery were evaluated to study the effectiveness of this surgery type. PSA testing, uroflowmetry with post-void residual urine measurement and IPSS questionnaire were carried out one month after surgery.Results. There was an improvement in all measurements one month after surgery: median values of the mean urine flow rate increased by 1.7 ml/s, median values of the max urine flow rate increased by 3.7 ml/s, the IPSS decreased by 12 points.Conclusion. Based on the results of the study, clinical observations, and statistical analysis of the data obtained, it can be concluded that laparoscopic radical prostatectomy with sparing of the proximal prostatic urethra is the preferred surgical option for this pathology, due to its organ-preserving nature.

Intestinal anastomoses in children: The draft decision of the Russian Symposium of Children surgeons (April 2023)

The Symposium of Pediatric Surgeons of Russia, Intestinal Anastomoses in Children, was conducted in Volgograd on April 26, 2023, with around 180 doctors in attendance. Thirty papers were presented and discussed, and 41 articles were published in the proceedings of the symposium. According to the results of a systemic analysis of a questionnaire poll of major pediatric surgeons in 75 regions of Russia, 4,558 surgeries on intestinal anastomosis formation were performed in 20212022, including 1,735 operations in newborn children (36%); their share in general pediatric surgery was less than 0.6%, and it was more than 18.6% in neonatal surgeons. The number of intestinal anastomoses formed during laparoscopic procedures increased (4.4%). Pediatric surgeons equally often used double-row nodal intestinal sutures (33.3%), single-row continuous sutures (34.6%), and different types of sutures (33.3%). A T-shaped anastomosis was performed in cases of necrotizing enterocolitis where there was a significant difference in the diameters of the intestine's inflow and outflow channels. The clip-and-drop technique was used to treat neonates with multifocal necroses. Interintestinal anastomoses were favored over enterostomies in numerous segmental resections. For duodenal obstruction, duodeno-duodenal, and duodeno-jejunal anastomoses were performed. In children with Crohn's disease and choledochal cysts, most specialists prefer operations with stapling devices. Creating a magnetic interintestinal anastomosis lowers the risk of postoperative complications and facilitates the postoperative period. Clinical observations after laparoscopic surgeries accounted for a significant proportion of complications (66%). Anastomosis failure was three times more common in planned small intestinal in older children than in emergency surgeries (1.2 and 0.4%, respectively).
 The modern stage of development of intestinal anastomosis formation techniques in children is characterized by good results, the expansion of indications for intestinal anastomosis in conditions of compromised colon or peritonitis, and the introduction of laparoscopic techniques and mechanical stapling devices with slightly poorer results.

Ультразвуковая эндоназальная дакриоцисториностомия в лечении рецидивирующего дакриоцистита новорожденного

Purpose. To evaluate early and long-term functional and anatomic results of surgical treatment of lacrimal pathways obstruction (LPO) in children with endonasal dacryocystorhinostomy (EDCR) method using ultrasound bone tissue dissector for the formation of nasolacrimal anastomosis. Material and methods. Surgical treatment of recurrent dacryocystitis of newborn (DN) after repeated unsuccessful «blind»lacrimal pathways probing in children with nasolacrimal duct obstruction, including cases of congenital nasolacrimal duct atresia. Bone «window» of the nasolacrimal anastomosis during endoscopic EDCR was formed using SONOCA 185 piezoelectric ultrasound dissector. In total, 14 children, 8 girls and 6 boys aged from 3 to 11 years (mean, 6 years) were operated with follow-up period of 6 months. Results. It was found that in all the children an adequate nasolacrimal anastomosis was formed without significant bleeding episodes both intraoperatively and in the early post-op period. No cases of destruction of the medial wall of the lacrimal sac were marked. Functional success was achieved in 92.8% (13 of14 cases). In 7.2% (1 of 14cases) there was a postoperative granuloma of the mucous in the rhinostoma region which was a partial obstacle for tear flow. Conclusions. Controlled low temperature process of nasal bones ultrasound dissection during EDCR in children allows formation of an adequate bone «window»and, therefore, a valuable nasolacrimal anastomosis in narrow nasal passages, makes the surgical procedure much easier and quicker, enables better healing of soft tissues in a shorter period. Key words: recurrent dacryocystitis of newborns, endonasal endoscopic dacryocystorhinostomy, ultrasound dissection of bone tissue

Right hemicolectomy for colon cancer: does the anastomotic configuration affect short-term outcomes?

Right hemicolectomy is a common colorectal operation for resection of cancers of the right colon. The ileocolic anastomosis may be created using a stapled end-to-side, stapled side-to-side or handsewn technique. Anastomotic leak and post-operative bleeding are uncommon but serious causes of morbidity and mortality, while post-operative ileus contributes to prolonged length of stay. The aim of this study was to evaluate differences in short-term outcomes between different anastomotic configurations following right hemicolectomy for colon cancer. We conducted a retrospective study using data from the Bowel Cancer Outcomes Registry (BCOR), including 94 hospitals across Australia and New Zealand, of all patients who underwent right hemicolectomy or extended right hemicolectomy for colon cancer with formation of a primary anastomosis between 2007 and 2021. We included 8164 patients in the analysis. There was no significant difference in rates of anastomotic leak and anastomotic bleeding based on anastomotic technique. A stapled end-to-side anastomosis was associated with a lower rate of post-operative ileus than stapled side-to-side anastomosis (6.5% vs. 7.2%; P = 0.03). Both handsewn and stapled anastomosis techniques may be utilized for oncologic right hemicolectomy, with comparable rates of anastomotic leak and post-operative bleeding. Stapled end-to-side anastomosis resulted in lower rates of prolonged ileus compared to stapled side-to-side anastomoses.

Transanal formation of anastomosis using C-REX device is feasible and effective in high anterior resection

PurposeC-REX is a novel instrument for creating stapleless colorectal anastomosis by compression. The aim of this study was to evaluate the feasibility and effectiveness of C-REX in open and laparoscopic high anterior resections.MethodsA prospective clinical safety study on 21 patients reconstructed with C-REX colorectal anastomosis following high anterior resection of the sigmoid colon using two different devices for intraabdominal (n = 6) or transanal (n = 15) placement of the anastomotic rings. Any signs of complications were prospectively monitored by a predefined protocol. Anastomotic contact pressure (ACP) was measured via a catheter-based system, and time for evacuation of the anastomotic rings by the natural route was noted. Blood samples were collected daily, and flexible endoscopy was performed postoperatively to examine macroscopic appearance of the anastomoses.ResultsOne of six patients operated with the intraabdominal anastomosis technique with an ACP of 50 mBar had to be reoperated because of anastomotic leakage. None of the 15 patients operated with the transanal technique (5 open and 10 laparoscopic procedures) had anastomotic complications, and their ACP ranged between 145 and 300 mBar. C-REX rings were uneventfully expelled by the natural route in all patients after a median of 10 days. Flexible endoscopy showed well-healed anastomoses without stenosis in 17 patients and a moderate subclinical stricture in one patient.ConclusionThese results indicate that the novel transanal C-REX device is a feasible and effective method for colorectal anastomosis following high anterior resections, irrespective of open or laparoscopic approach. Moreover, C-REX allows measurement of intraoperative ACP and thereby a quantitative evaluation of the anastomotic integrity.

Laparoscopic right hemicolectomy with intracorporeal ileo-transverse anastomosis (review)

Colon cancer is one of the most common malignant tumors worldwide. The main treatment for localized colon cancer is surgery. Nowadays laparoscopic colectomies for colon cancer have advantages over open ones, as they provide better short-term results. There has been a continuous improvement in the technique of the operation, and due to the widespread use of laparoscopic stapling and cutting devices, intracorporeal anastomosis is becoming more and more accessible. This article discusses the advantages and disadvantages of various methods for the formation of ileo-transverse anastomosis in laparoscopic right hemicolectomy.

Salvage surgery is an effective alternative for J-pouch afferent limb stricture treatment

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients requiring surgery for inflammatory bowel disease. A stricture located at the inlet of the afferent limb can lead to small bowel obstruction in a limited number of patients with a pelvic pouch. This paper aims to examine our experience with afferent limb stricture surgical correction when other endoscopic treatment methods have failed to control obstructive symptoms. All consecutive eligible patients with ileal pouch-anal anastomosis and afferent limb stricture were identified from our institutional review board-approved database from 1990 to 2021. Patients surgically treated with excision and reimplantation/strictureplasty of afferent limb stricture were included in this study. Twenty patients met our inclusion criteria. Fifteen (75%) were female, and the overall mean age was 41 ± 10.3 years at afferent limb stricture surgery. The interval from ileal pouch-anal anastomosis formation to surgery for afferent limb stricture was 13.5 ± 6.7 years. Nine (45%) underwent strictureplasty, and 11 (55%) had resection and reimplantation of the afferent limb into the pouch. Before afferent limb stricture surgery, 3 (15%) required a diverting ileostomy for their obstructive symptoms. An additional 12 (60%) had a stoma constructed during afferent limb stricture surgery, and 5 had a strictureplasty and no stoma. Postoperatively, 1 patient (5%) had a leak at the afferent limb stricture repairsite. All patients had their ileostomy closed 3.2 (2.99-3.6) months after surgery. Long-term after afferent limb stricture surgery, recurrent small bowel obstruction symptoms recurred in 7 (35%) patients 3.9 (2.6-5.8) years later. Afferent limb stricture can be treated effectively with salvage surgery. The surgical intervention appears durable and provides an acceptable outcome for their obstructive symptoms.

Compression anastomoses in colon surgery (literature review)

А review of domestic and foreign literature on compression methods for the formation of colonic anastomoses is presented in the paper. Despite advances in the improvement of the manual suture of the colon, the frequency of postoperative complications remains high – 68.7%, while mortality ranges from 1% to 26%. Thus, it was not possible to achieve the absolute reliability of the traditional manual suture in the formation of colonic anastomoses. Compression anastomosis has an advantage over manual. When forming an anastomosis using a compression method, a decrease in time was noted, ease of creating an anastomosis, a significant decrease in postoperative complications and a high quality of the formed anastomoses, confirmed by morphological studies.

Radiodiagnosis of multiple syphilitic aneurysms and great vessels: case report

Cardiovascular syphilis has a variety of localizations and signs including an aortic aneurysm. Syphilitic aneurysms are most commonly localized in the ascending aorta, less in the aortic arch and descending aorta. Multiple aneurysms of syphilitic etiology are rare. A clinical case of a 56-year-old patient with multiple aneurysms of the aorta and brachiocephalic trunk of syphilitic etiology has been reported. Computed tomography showed multiple aneurysms of various localization, rupture of the ascending aortic aneurysm with partial thrombosis, its localization and the formation of an aortopulmonary anastomosis. The data obtained made it possible to carry out surgical treatment.

Фотодинамическая терапия культи прямой кишки у больных язвенным проктитом

INTRODUCTION: Ulcerative colitis is a severe disease significantly reducing the patient’s quality of life. Approximately one third of patients per year suffering from this disease have indications for a surgical treatment — colectomy with ileostomy. Subsequently, not all patients appear suitable for reconstructive surgery, for which reason they are doomed to a life-long ileostomy. These facts stimulate us to search for new methods of treatment of the rectal stump remaining after colectomy. In this study, 10 patients having been operated for ulcerative colitis and having rectal proctitis, underwent a single session of photodynamic therapy. The effectiveness of photodynamic therapy was controlled before the session and one month after it using rectoscopy with rectal mucosa biopsy. Endoscopy results were evaluated on Shroeder and UCEIS scales. The results of histological examination were evaluated on Geboes scale. Maximum accumulation of Photoditazin in rectal stump affected with ulcerative proctitis, was determined after 1.5–2 hours. Upon achievement of this maximum, fluorescence of the rectal mucosa 10.8 times exceeded the initial level, while in the intact tissues, fluorescence increases only 2.8 times. After a session of photodynamic therapy, the level of fluorescence of the rectal mucosa reduced 3.11 times, which indicates a photochemical reaction (positive photobleaching) in the tissue. In evaluation of effectiveness of photodynamic therapy after a month, 9 patients of 10 showed improvement of endoscopic and histologic picture. In 2 patients, remission was achieved, in 7, the activity of ulcerative proctitis declined from moderate to mild level. In one patient, no changes were revealed on evaluated scales. In 90% of patients, a single session of photodynamic therapy showed a positive effect, but taking into account a small sample size and the absence of control group, further data collection with subsequent statistical analysis is planned. CONCLUSION: Photodynamic therapy of rectal stump in the operated patients with ulcerative proctitis can be considered an additional method of treatment and preparation for reconstructive surgery for formation of ileorectal anastomosis.

Does the type of anastomosis affect the risk of recurrence in Crohn disease?

AIM: to evaluate the effect of intestinal anastomosis type on risk of Crohn’s disease (CD) recurrence.PATIENTS AND METHODS: the retrospective cohort study included 130 patients with CD who underwent surgery for a complicated CD in 2012–2017. Ileocecal resection with anastomosis was performed in 112/130 (86.2%) patients. Resection of the terminal ileum with resection of the right side of the colon with the formation of an ileo-transverse anastomosis. In 18/130 (13.2%) cases. Stapled “side-to-side” anastomosis was formed in 57/130 (43.8%) patients, while hand sewn “end-to-end” — in 73/130 (56.2%) patients. Post-op complications occurred in 21/130 (16.2%) cases. After surgery, most patients were treated by azathioprine as an anti-recurrence therapy — 112/130 (86.2%) patients, while in 31/112 (23.8%) cases, additional biological therapy was done. In 14/130 (10.7%) patients, anti-recurrence therapy was carried out in mono mode with a biological drug.RESULTS: mean follow-up was 28.5 (1.9–95.4) months. Recurrence occurred in 54/130 (41.5%) patients on average 18 ± 5 (12–41) months after surgery. Thus, the operative time exceeding 200 minutes was significantly associated with an increase in the recurrence rate (p = 0.03). It was found that the type of anastomosis does not affect the recurrence risk. Moreover, among the significant factors was the operative time. It increases the chance of recurrence by 2.9 times in the univariate model (p < 0.05), and in the multivariate model — by 6.3 times, when exceeding 155 minutes.CONCLUSION: the type of anastomosis does not affect the recurrence risk. The operation time exceeding 155 minutes increases the chance of recurrence by 6 times (p < 0.01).

Slow gastric emptying after pancreaticoduodenectomy: analysis of the impact factors

Objective. To investigate the efficacy of existing methods of formation of anastomoses and to determine the factors, influencing development of slow gastric emptying.
 Materials and methods. Retrospective investigation was conducted on 102 patients in Jan. 2019 – Nov. 2021 yrs period, in whom pyloro-preserving pancreaticoduodenectomy in accordance to Traverso was performed versus excision of pylorus in accordance to Whipple. The patients were distributed into two Groups: Group I - 26 patients, in whom the operation was complicated by slow gastric emptying, and Group II - 76 without such symptoms.
 Results. Postoperative complications were diagnosed in 43 (42.2%) patients, and slow gastric emptying - in 26 (25.5%). External pancreatic fistula was revealed in 14 (13.7%) patients, while clinically significant fistulas of grades B and C - in 9 (8.8%). Among 26 patients with slow gastric emptying in 16 there was grade of severity A, in 8 - B, and in 2 - C. Thus, the gastrojejunostomy type applied statistically significantly (p < 0.05) influenced a slow gastric emptying occurrence. The type of pancreatojejunostomy applied did not influenced (p = 0.85) a slow gastric emptying occurrence. The patients with complications have had more stationary stay – by 6 days at average. General surgical complications, pancreatic fistulas statistically significantly (p ≤ 0.001and p < 0.05, accordingly) were connected with clinically significant slow gastric emptying; while concerning biliary fistulas, hemorrhage such a correlation was not revealed (p = 0.75 and p = 0.44, accordingly).
 Conclusion. External pancreatic fistula and common surgical complications, the gut reconstruction pattern in pancreaticoduodenectomy (antecolic or retrocolic), connected with insufficient gastric evacuation, were determined as the main influencing factors in development of gastric motor function disorders. The patients with slow gastric emptying need complex conservative treatment and long period of time for their evacuation function restoration. For such patients it is necessary to guarantee a selective help and rapid ways of rehabilitation, as well as to prevent the complications occurrence. Thus, it is necessary to proceed with further investigations for surgical reconstructive procedures in pancreaticoduodenectomy.

Possibilities of tissue perfusion assessment in abdominal surgery: integration into the intraoperative system of safety control points

To evaluate the possibility of integrating tissue perfusion assessment techniques (ICG perfusion and imaging photoplethysmography - iPPG) into the system of intraoperative control points of laparoscopic interventions with a reconstructive component. Quantitative assessment of ICG fluorescence and iPPG were used during 8 laparoscopically assisted interventions: gastrectomy for gastric cancer (total - 2 and distal - 1) and colorectal resections (left-sided colorectal resections - 4 and right hemicolectomy - 1). Four stages are presented for the assessment of tissue perfusion: initial assessment, before intestine transection, before anastomosis formation, and evaluation of anastomosis. From the point of view of the significance of clinical decision-making, the «before intestine transection» stage is of great importance, due to the ease of transferring the resection level to the optimal tissue perfusion zone. Integration of tissue perfusion assessment techniques into the system of intraoperative checkpoints is possible and promising.

PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE CANCER OF THE HEAD OF THE PANCREAS COMPLICATED BY MECHANICAL JAUNDICE.

The aim: To improve the results of palliative surgical treatment of patients with unresectable cancer of the head of the pancreas, complicated by obstructive jaundice, disturbances of evacuation from the stomach, cancerous pancreatitis by improving surgical tactics and techniques of surgical interventions.. Materials and methods: There were 277 patients with unresectable cancer of the head of the pancreas participated in the study, who were divided into control (n=159) and main (n=118) groups depending on treatment tactics. . Results: The operation of choice in the surgical treatment of patients with unresectable cancer of the head of the pancreas, complicated by obturation of the biliary system and duodenum with a high surgical risk is endoscopic stenting of the bile ducts and duodenum with nitinol stents, which is accompanied by a decrease in the frequency of postoperative complications from 72.7 to 29.6% (χ2=5.8, 95% CI 8.26-65.39, p=0.01), mortality from 36.4% to 0.0% (χ2=10.69, 95% CI 11.8- 64.65, p=0.001). The patient's formation of biliodigestive and prophylactic gastrodigestive anastomosis is an effective and safe procedure, which, in comparison with only biliodigestive shunting, reduces the frequency of postoperative complications by 16.2% (χ2=6.61, 95% CI 3.69-30.89, p=0.01), improves quality of life and prevents repeated surgical operations to restore evacuation from the stomach. Conclusions: The use of the proposed surgical tactics and technique of surgical interventions in patients with unresectable cancer of the head of the pancreas, complicated by obstructive jaundice, disturbances of evacuation from the stomach, cancerous pancreatitis made it possible to reduce the frequency of complications by 9.3% (χ2=3.94, 95% CI 0.09-17.86, p=0.04) and fatal cases by 5.8% (χ2=4.5, 95% CI 0.42-12.72, p=0.03).

Prognostic factors of dehydration and renal damage in patients with formed preventive ileostomy during rectal resection for cancer

To determine the potential prognostic factors of complications associated with ileostomy dysfunction in patients who have undergone rectal resection for cancer. We retrospectively analyzed patients over the age of 18 who underwent open and laparoscopic resection of the rectum with the formation of a preventive ileostomy from January 2015 to May 2022. To determine the influence of potential predictors on the frequency of complications associated with large ileostomy losses, a single-factor logistic regression analysis was used. Complications associated with large ileostomy losses were primarily water-electrolyte disorders, dehydration and acute renal failure, which required intensive therapy and re-hospitalization. Of the 120 patients included in the study, 26 (21.7%) suffered complications associated with large losses of fluid and electrolytes in the stoma. In this group of patients, at least one repeated emergency hospitalization to a medical institution was required (average value 1.6). Factors associated with ileostomy dysfunction in a single-factor analysis were: the presence of signs of intestinal obstruction (OR=2.6; p=0.047), the development of postoperative complications (OR=3; p=0.024), steroid use (OR=4.3; p=0.010), smoking (OR=4.8; p=0.017) the average amount of discharge from the stoma at discharge is more than 1000 ml/24 h (OR=3.2; p=0.016) and the need for Loperamide at the time of discharge (OR=2.8; p=0.032). Multivariate logistic regression analysis revealed an independent risk factor for complications leading to re-hospitalization: ileostomy losses at discharge ≥1000 ml/24 h (OR=3.3 (1.18-9.37); p=0.023). In our study, those patients whose ileostomy discharge exceeded 1000 ml/24 h at discharge were at increased risk of dehydration, hypokalemia, hypocalcemia, acute prerenal renal failure, which led to repeated hospitalization to correct these disorders, sometimes in the intensive care unit.

Evolution of interventional endoscopic ultrasound.

Endoscopic ultrasound (EUS) has become an indispensable modality for the assessment of the gastrointestinal tract and adjacent structures since its origin in the 1980s. Following the development of the linear echoendoscope, EUS has evolved from a purely diagnostic modality to a sophisticated tool for intervention, with numerous luminal, pancreaticobiliary, and hepatic applications. Broadly, these applications may be subdivided into three categories: transluminal drainage or access procedures, injection therapy, and EUS-guided liver interventions. Transluminal drainage or access procedures include management of pancreatic fluid collection, EUS-guided biliary drainage, EUS-guided bile duct drainage, EUS-guided pancreatic duct drainage, and enteral anastomosis formation. Injection therapies include therapeutic EUS-guided injections for management of malignancies accessible by EUS. EUS-guided liver applications include EUS-guided liver biopsy, EUS-guided portal pressure gradient measurement, and EUS-guided vascular therapies. In this review, we discuss the origins of each of these EUS applications, evolution of techniques leading to the current status, and future directions of EUS-guided interventional therapy.

Morphological Peculiarities of the Pelvic Autonomic Nervous System and Their Impact on Clinical Interventions in the Lesser Pelvic Region.

Background: The aim of the work is to define the morphological peculiarities of the pelvic autonomic nervous system (ANS) and their importance in the clinical and surgical interventions in the lesser pelvis. Material and methods: Anatomical variations in the formation of the pelvic ANS were observed in 20 cadavers. The study included 17 men (85%), aged 18 to 84, and 3 women, aged 27 to 86. The average age was 53.8 years. The subjects most often died by violent death in car accidents, by asphyxia, or by sudden death. The study was approved by the Ethics Committee of the Health Care Surveillance Authority, Bratislava, Slovakia. We studied cadavers without congenital or detected anomalies, cancer, deformities of the body, or spinal or abdominal surgeries within 24 h of death. We observed a relationship between the dimensions and the number of ganglia, as well as the number and course of nerve branches and anastomoses. In the pelvic area, we observed the hypogastric plexus superior, hypogastric plexus inferior, and the truncus sympathicus. In all cadavers, we clarified the lumbosacral plexuses after evisceration. In the lumbosacral region, the roots were defined based on their participation in the formation of the plexuses. To show the intimate relationship between both systems, we also focused on the details of the structure (rami communicantes) related to the connections of the ANS with the spinal nervous system. Results: Anatomical variations in the formation of the pelvic ANS were observed in all cases. We included cases with more than two truncus sympathicus ganglia as the segmental type. The segmental form occurred in 14 (70%) cases, and was concentrated in 6 (30%) cases. Rami communicantes provided anastomoses to the spinal nerves. Small ganglia were observed on the rami communicantes. With the concentrated type, we observed the division of the sympathetic and parasympathetic systems. With the segmental and concentrated forms, symptoms of the "diffuse form" may occur, which we observed in all cases. We observed significant right-left asymmetry and differences in the formation of ganglia and anastomoses. Conclusions: This study allowed us to identify and describe the morphological peculiarities of the pelvic ANS and their possible influence on the clinical picture. Asymmetry and dependence of their occurrence on the type of ANS was observed. The variations were frequent. Their preoperative diagnosis is difficult to impossible. The absence or lack of intraoperative vigilance can lead to the damage of pelvic ANS during operations and blockades of the pelvic plexus. The acquired knowledge can be helpful in clarifying clinical signs and symptoms of these conditions.

Predictive Factors for Anastomotic Leak in Colorectal Surgery: A Bi-National Database Study

IntroductionAnastomotic leak (AL) is a serious complication following colorectal surgery. This study aimed to identify factors associated with the development of AL and analyze its impact on survival.Materials and MethodsAll consecutive adult colorectal cancer resections with curative intent and anastomosis formation were included from a prospectively maintained bi-national database between 2007 and 2020. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS).ResultsThere were 7566 eligible patients. The rate of AL was 2.3% and 4.4% in patients with colon and rectal cancer respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (Odds ratio 1.999, p = 0.017). Emergency surgery (p = 0.013), surgery at a public hospital (p < 0.01), and an open surgical approach (p = 0.002) were all significantly associated with a higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (6.8% vs 1.6%, p < 0.05). In rectal cancer patients, ultra-low anterior resections had the highest risk of AL (4.6%), and associations were found with neoadjuvant chemotherapy (p = 0.011), surgery in a public hospital (p = 0.019), and an open approach (p = 0.035). Anastomosis formation technique (hand-sewn vs stapled) did not impact on rate of AL.DiscussionClinicians should be cognizant of the predictive factors for AL and consider early intervention for patients at risk of this.

Surgical tactics in peritonitis, caused by complicated course of colorectal cancer

Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer.
 Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV.
 Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome.
 Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.