[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[Surgical strategy for acute biliary pancreatitis]. / Khirurgicheskaia taktika v ostroi stadii biliarnogo pankreatita.

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.

[Experience of using an individual approach in the anal fissures treatment]. / Opyt ispol'zovaniia individual'nogo podkhoda v lechenii anal'nykh treshchin.

AIM: To objectify the criteria for choosing the method of treatment of anal fissures, to determine the indications for surgery and sphincterotomy. MATERIAL AND METHODS: The results of treatment of 206 patients with chronic and acute anal fissures between the ages of 17 to 75 years are analyzed. The posterior anal fissure was detected in 175 (84.9%) patients, the front - in 18 (8.7%), the combination of fissures was noted 13 (6.3%) times. The history of the disease - from 1 month to 12 years. The examination included analysis of clinical data, indicators of pre- and postoperative anorectal manometry, endorectal ultrasound. The period of postoperative monitoring is from 6 to 12 months, control examinations with a functional study of the anal sphincters were carried out 1 and 2 months after healing. Concomitant hemorrhoids were noted in 65 (31.5%) patients, of which 20 (9.7%) patients were simultaneously hemorrhoidectomized. In 11 (5.3%) patients, simultaneous operations were performed in the presence of paraproctitis, rectal fistula. RESULTS: In 77.8% of patients with acute fissures, the use of conservative therapy, which included myotropic antispasmodics and local application of glycerol trinitrate made it possible to achieve healing of fissures without surgery. Operated 185 (89.8%) patients. With an increase in the basal anal pressure at the level of the internal sphincter, an increase in the average pressure in the anal canal, a decrease in the amplitude and duration of the rectoanal reflex, the indications for dosed sphincterotomy were determined in 167 patients. At the same time, in 117 persons, the excision of fissures was supplemented with a lateral 'closed' sphincterotomy, in 50 cases the posterior 'open' dosed sphincterotomy was performed. In 18 (9.7% of the operated ones) patients in the absence of sphincter hypertonus, the fissures were excised without sphincterotomy. The best functional results were obtained after performing the lateral 'closed' subcutaneous sphincterotomy. It was noticed that in the absence of characteristic complaints and clinical manifestations of incontinence, in 14 patients there was a decrease in the average pressure in the anal canal at rest and with volitional contraction. At the same time, 6 patients out of 14 belonged to the older age groups, and in 9 women there was a rectocele, pelvic floor prolapse. Postoperative incontinence was not observed. Recovery with complete epithelialization of the anoderm defect and the absence of complaints was achieved in 191 (92.7%) patients, satisfactory results (healing of fissures in the presence of pain or proctitis) - in 8 (3.9%) and in 7 (3.4%) patients relapse of the disease was noted with the ineffectiveness of therapy. CONCLUSION: The ineffectiveness of complex conservative treatment for more than two weeks, with a history of more than 3 months, is an indication for surgical treatment. Preoperative functional and clinical and physiological examination of patients allows the formation of surgical tactics. A differentiated approach to the choice of treatment method, as well as individual determination of indications for surgery and sphincterotomy can improve long-term results. The technique of simultaneous operations with the combination of anal fissure and other proctological diseases needs to be improved.

[Non-opioid multimodal anesthesia in the surgical treatment of colorectal cancer]. / Bezopioidnaia mul'timodal'naia anesteziia v khirurgicheskom lechenii kolorektal'nogo raka.

This article deal with method of multimodal, opioid-free anesthesia for colorectal surgery in the perioperative period. AIM: To improve the quality of treatment for patients with colorectal cancer using non-opioid anesthesia and analgesia in the perioperative period. MATERIAL AND METHODS: The study included 47 patients who underwent laparoscopic colon surgery. This anesthesia method consists of epidural anesthesia with sevoflurane during surgery end epidural analgesia after surgery. We describe the method of non-opioid anesthesia technics during colorectal surgery. The pain syndrome was evaluated at various time intervals. Harvard standard for monitoring during anesthesia is presented. RESULTS: Opioid-free anesthesia is safety method for colorectal surgery. It was also possible to reduce the incidence of postoperative nausea and vomiting, pain, intestinal paresis, the duration of hospitalization, and rise quality of medical care for patient with colorectal cancer.

[Fast-tract: Therapist's role]. / Fast Track: rol' terapevta-gospitalista.

The modern model of inpatient surgical care of private and optimized state/govermental medical institutions allows us to change the paradigm of nosological attachment of the hospital bed to one profile of specialists for an adaptive model, when the wards can be reassigned depending on the needs of the hospital. In such multidisciplinary medical centers with mixed hospital beds without a nominal distinction in the nosological departments, a new therapeutic service is being developed - hospitalists, which provide a consistent curation of hospitalized patients, compensation of chronic therapeutic illnesses with patient's preparation for surgical interventions. Our work describes the experience of Fast Track recovery program with the active participation of a hospitalist in a surgical team, which is a new experience in the practice of Russian colorectal surgery.

[Sphincter-sparing treatment of anal fissure]. / Sfinkterosokhraniaiushchaia taktika lecheniia patsientov s anal'noi treshchinoi.

Surgical treatment of the anal fissure is associated with unreasonably high risks of delayed development of fecal incontinence to gas or liquid stool. Standardized sphincter-preserving therapy, based on the pharmacological reduction of increased internal anal sphincter tone (chemical sphincterotomy) allows to improve significantly the results of the non-surgical approach of treating one of the most common pathology in proctological practice. Our work presents a retrospective analysis of the treatment of 295 patients with anal fissure treated with diltiazem ointment, nifedipine ointment, nitroglycerin ointment and botulinum toxin A. Significant improvement or disappearance of complaints was noted in 84% of patients. The use of botulinum toxin A was successfull in 10 out of 11 patients without the need of surgical intervention. High efficiency (91% of patients) of the sphincter-preserving approach with a significant decrease in the need for aggressive surgical manipulation allows to decrease sphincterotomy rate and reduces the risk of delayed fecal incontinence.

[A doctor in social networks: opportunities or limitations?] / Vrach v sotsial'nykh setiakh: vozmozhnosti ili ogranicheniia?

Social media opens great opportunities in doctors' practice, education and communication with patients. The information is published easily and instantly, just by 'click', but sometimes it's not enough time for the author to think over issues of ethics, compliance with the professional standard, the validity of statements and their reliability. On the other hand, the capabilities of the Internet can detect any publication even after its removal. Currently there are no official guidelines regulating the rules of doctor's behavior in social media in Russia. In this article we will discuss what to keep in mind while using these new opportunities effectively and safely.

[Common sense of diosmin administration in combined treatment of hemorrhoids]. / Zdravyi smysl primeneniia diosmina v kombinirovannom lechenii gemorroia.

Flavonoids are herbal medicines and widely used for chronic venous diseases and hemorrhoids. Flavonoid diosmin in both micronized and non-micronized form is a part of various drugs. According to literature data, flavonoids are able to reduce venous stasis, suppress local inflammation, improve venous tone and lymphatic outflow. It should be noted that biological models of in vivo trials have certain limitations while available data of different researches are contradictory. However, flavonoids were recommended for hemorrhoids in view of meta-analysis of 14 trials comparing flavonoids (diosmin, micronized purified flavonoid fraction and rutosides) with placebo in 1514 patients with hemorrhoids and Cochrane review of 24 randomized controlled trials (2,334 participants). These drugs should be administered as a part of complex therapy. At the same time, there is no conclusive evidence to prefer only one of these medicines. There are also no data confirming the benefits of daily dosage of 3000 mg per day of micronized fraction of flavonoids compared with 1800 mg of purified diosmin per day for treatment of acute hemorrhoids.

[Endoscopic tattooing of colorectal neoplasms and laparoscopic surgery: technical aspects and recommendations]. / Éndoskopicheskii tatuazh obrazovanii tolstoi kishki i laparoskopicheskaia khirurgiia. Tekhnicheskie aspekty i rekomendatsii.

Accurate mapping of colorectal neoplasms is needed in many clinical situations. Intraoperative mapping of small lesions previously detected by endoscopy is often challenging, especially during laparoscopic surgery. Tumor location assessed during colonoscopy may be inaccurate because of limitations of the procedure. Small flat neoplasms with signs of invasiveness, which are hard to detect by palpation, hold a special place. The same situation is observed for nonradical endoscopic resection of malignant polyps or early cancer, when visual examination shows that the tumor masses have been completely resected but histological examination reveals the positive lateral or horizontal resection margin. Endoscopic tattooing is an effective, safe, and economically sound method to mark intraluminal colorectal neoplasms, which allows one to perform minimally invasive surgeries without using additional operating room resources.

[The paraaortic lymphadenectomy with the lower mesenteric artery sceletonization for the sigmoid cancer treatment].

43 patients with sigmoid cancer stage I--III were operated on. The mean operative time was 206.2±73.0 min, considering the sceletonization of the lower mesenteric artery together with the paraaortic lymphadenectomy took 28±9 min. The long-term follow-up was performed in all the patients. The median follow-up time was 39.35±13.1 months. 4 patients had died, 3 of them because of the cancer progression. The paraaortic lymphadenectomy with the lower mesenteric artery sceletonization is now considered to be the method of choice in treatment of sigmoid cancer. The operation is reasonably safe considering the rate of intra- and postoperative complication rate.

En bloc resection of abdominal aorta and paraaortic lymph node metastasis of sigmoid cancer.

The surgical management of colorectal metastasis is becoming a widespread practice in oncology. Synchronous resection of metastasis together with invaded major vessels (aorta) is still considered an extremely aggressive procedure. We demonstrate that en bloc resection of invaded aorta and paraaortic lymph node metastasis can be safely performed. The literature from experiences with similar techniques is also discussed.