[Reversal of Hartmann's procedure in patients with diverticular disease]. / Rekonstruktivno-vosstanovitel'nye vmeshatel'stva posle operatsii Gartmana u patsientov s divertikulyarnoi bolezn'yu.

OBJECTIVE: To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease. MATERIAL AND METHODS: A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12). RESULTS: Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% (n=10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery. CONCLUSION: In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.

[The results of colorectal resection for bowel deep infiltrating endometriosis]. / Osobennosti kolorektal'nykh rezektsii pri glubokom infil'trativnom endometrioze.

OBJECTIVE: To study the early postoperative outcomes of segmental bowel resections in patients with colorectal endometriosis. MATERIAL AND METHODS: A retrospective study included 60 patients diagnosed with deep infiltrative endometriosis who underwent surgical treatment with segmental bowel resection between 2016 and 2022. RESULTS: All surgeries performed by two teams (gynecologic & colorectal). 59 operations were performed by laparoscopic access and one open. The average operation time was 263.5±86.0 min, estimated blood loss 126.1 ml (10-400 ml). There were no intraoperative complications. There were no conversions during laparoscopic surgery. A protective stoma was not required in any patient. The median postoperative hospital stay was 7.5±4.2 days. Bowel function was restored by an average of 4.3±3.1 days. Postoperative complications were in 7 cases (11.6%). Anastomotic leakage occurred in one patient (1.6%). The incidence of urine retention requiring repeated bladder catheterization was 2 (3.3%). CONCLUSION: The use of a minimally invasive multidisciplinary approach makes it possible to perform the required volume of surgery with excision of all tissues affected by endometriosis with a low level of complications and the absence of conversions.

Effect of Neoadjuvant Chemoradiation Therapy on Proteasome Pool in Rectal Cancer.

In untreated rectal cancer patients, the chymotrypsin-like activity of proteasomes in tumor tissue was 3-fold higher than that in conventionally normal tissue, which is explained by up-regulation of expression of immunoproteasomes and total pool of proteasomes. After neoadjuvant chemoradiation therapy, expressions of the total pool of proteasomes and immunoproteasomes in the tumor as well as the relative ratios of these indices to those in conventionally normal tissue were smaller by 1.4-3.3 times in comparison with the untreated patients. These changes were paralleled with pronounced (4.5-fold) down-regulation of proteasome activity in the tumor and a 3.7-fold decrease of activity ratio for the proteasomes in tumor and in conventionally normal tissue. The number of immunoproteasome subunits and the chymotrypsin-like activity of proteasomes can be viewed as potential markers to prognosticate effectiveness of neoadjuvant chemoradiation therapy in rectal cancer patients.

[Prevention of paracolostomic hernia]. / Profilaktika parakolostomicheskoi gryzhi.

AIM: To improve the prevention of paracolostomic hernias. MATERIAL AND METHODS: We studied the prevention of paracolostomic hernia using mesh allograft. The study involved 73 patients with low-ampullary rectal cancer. Open or laparoscopic abdominoperineal extirpation of rectum was performed in all observations. 21 patients underwent prophylactic Sugarbaker's repair of paracolostomic area. We used the modifications of this surgical stage for transabdominal and retroperitoneal stoma. RESULTS: There were no postoperative complications associated with the use of allograft. The hernia occurred in one case (4.8%) of prevention group and in 14 (26.9%) patients of control group. CONCLUSION: The first results of composite allograft application to prevent paracolostomic hernias are encouraging. The absence of specific complications and favorable long-term results allow to continue the investigation.

[Transanal endoscopic microsurgery].

AIM: To analyze the immediate and remote results of transanal endoscopic microsurgical intervantions and its role in treatment of rectal tumors. MATERIAL AND METHODS: The results of transanal endoscopic microsurgery in 56 patients with rectal tumors were studied. Adenoma and adenocarcinoma were observed in 45 (80%) and 11 (20%) patients respectively. Mean height of tumor lower edge placement was 8.6 ± 0.3 cm from anus, mean diameter - 3.7 ± 0.3 cm. All patients underwent full-layer resection of rectum. RESULTS: Postoperative complications were observed in 4 (7%) patients. There were no deaths. Transanal endoscopic microsurgery is modern, adequate and effective treatment of benign and early forms of malignant rectal tumors. It is associated with lower incidence of complications and recurrence under condition of careful selection of patients. Based on obtained results we recommend surgeons to apply this technique only in case of tumor placement below 10-11 cm from anus and tumor's diameter up to 3-4 cm to minimize risk of complications and recurrences. Full-layer resection of rectum is recommended in all cases of operations for benign tumors because of there is high risk of latent malignancy.

[The use of stapling sutures by right hemicolectomy].

90 right hemicolectomies (RH) were performed in 2011-2012 yy using the stapled (circular and linear) ileocolic end-to-side anastomosis. This group was compared with 100 RH (2002-2005 yy), performed using linear stapled biangular end-to-end anastomosis. All patients had verified colon cancer. Thу mean operative time in the main group was 100±37 min (p>0.05). The time of the anastomosis formation was 7±1.2 min (p>0.05). There were no anastomosis dehiscence and postoperative mortality registered. Re-operation rate was 1.1%. The comparison of two methods revealed, that the end-to-side anastomosis obtained lower risk of postoperative complications (12 vs 26%; p=0.016), anastomosistis (1 vs 8%; p=0.02) and anastomotic dehiscence (0 vs 3%; p>0.05). Therefore, the ileocolic end-to-side anastomosis with circular and linear staplers proved to be a safe method of colon cancer treatment and guarantee the minimal risk of insufficiency and lethality.

[Laparoscopic peritoneoanal resection of rectum with coloanal anastomosis].

65 laparoscopic peritoneoanal resections were performed. 80 patients, who underwent the traditional open surgery, comprised the control group. The mean operative time for the laparoscopic procedure was 202+/-47.7 min. Conversion was performed in 2 cases. A delayed transversostomy was performed in 10 cases because of the coloanal anastomosis ischemia. Lethality rate was 3%. 5-year survival was 76.9% after the radical laparoscopic procedure.