Analysis of the factors affecting the state of the rectal closure system in ostomy patients at the stages of surgical rehabilitation

There are few publications in scientific literature devoted to the assessment of the rectal closure apparatus at the stages of surgical rehabilitation of ostomy patients. Aim of the study was to investigate the factors influencing the change in the functional activity of the rectal closure apparatus in patients with intestinal stomas. Material and methods. A single- center retrospective and prospective analysis of the results of changes in the function of the rectum closure system in 83 patients before and after reconstructive operation was performed. For the period from 2016 to 2018, 42 (50.6 %) men and 41 (49.4 %) women were examined, the average age in the group was 51.8 ± 12.6 years. Results and discussion. In all ostomy patients, anal sphincter incontinence was revealed. In this case, the relationship between the degree of impaired functional activity of the closure system of rectum, the duration of stoma wearing, and the age of the patient was determined. Conclusions. An analysis of the results allows us to evaluate the dynamics of the restoration of the function of the rectum closure apparatus and determine the optimal time for performing the restorative intervention from the standpoint of prophylaxis of dysfunction of the rectum closure system

Modern management of acute non-variceal upper gastrointestinal bleeding

Acute, non-varicose bleeding from the upper gastrointestinal tract remains a common clinical problem. Bleeding episodes are associated with high mortality and a significant economic burden on the health care system. Despite the continuing improvement in endoscopic treatment, recurrent bleeding and associated mortality are still a pressing issue. In addition to the well-established modalities of endoscopic hemostasis: injection, thermal, mechanical, used both as mono therapy and as part of a combination therapy, the review discusses the use of novel types of endoscopic devices. The results of the use of over-the-scope clips, coagrasper, hemostatic sprays, endoscopic angiography, radiofrequency ablation, cryotherapy and endoscopic suturing device are described. The technical aspects of their application, the issues of efficacy and safety, the advantages and limitations of methods for achieving final endoscopic hemostasis are considered. The methods of initial assessment and treatment strategies for recurrent bleeding and unsuccessful endoscopic hemostasis were also analyzed. Material and methods. Literature search was carried out using the following electronic information resources: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Results. Сombined endoscopic hemostasis is a standard therapy in the treatment of gastrointestinal tract cerebral infections with an efficiency of 95-98 %, new modalities of endoscopic hemostasis are able, in some cases, to achieve final endoscopic hemostasis both in primary endoscopic treatment and in recurrent bleeding

Preparing the upper gastrointestinal tract for an esophagogastroduodenoscopy to identify the source of acute bleeding

Esophagogastroduodenoscopy (EGDS) is the main way to diagnose bleeding from the upper gastrointestinal tract. Diagnostic accuracy of the study depends on the preparation. Aim of the study was to evaluate the preparation of the upper parts of the digestive tract in case of esophagogastroduodenal bleeding. Material and methods. The retrospective analysis of 2570 case histories was carried out. Gastric lavage through nasogastric tube was carried out in the main group (1299 patients). Preparation for the primary EGDS was not carried out in the control group (1271 patients). A comparison of the number of EGDS performed and the detection of the bleeding source in the control and the main groups as well as the period of investigation up to the detection of the bleeding source were performed. Results. EGDS without preparation of the upper gastrointestinal tract in case of acute bleeding and determination of the diagnosis is possible in 85,6 % of patients. Preparation of the upper gastrointestinal tract for EGDS prolongs the study period by 30–60 minutes, but allows establishing the diagnosis in 93.7 % of cases that is by 8.1 % more than without preparation

Роль консервативной терапии в лечении осложненного колоректального рака

Objective: to evaluate the possibilities of conservative treatment of patients with complications of colorectal cancer.Materials and methods. The study included the results of treatment of 105 patients with complications of colorectal cancer treated on the basis of the District Clinical Hospital of Surgut for the period 2012—2017. Of these, 86 (81.9 %) patients with acute obstructive intestinal obstruction, 11 (10.5 %) patients with bleeding from colon tumors, and 8 (7.6 %) patients with purulent-septic complications of colon cancer.Results. The complex of conservative measures, including colon stenting, provides restoration of the passage through the digestive tract in 79.1 % of patients, which allows preparing the patient to perform surgery, thereby reducing the risk of complications. Twenty-eight (27.6 %) patients were operated on an emergency basis: due to the lack of effect from conservative therapy for acute intestinal obstruction — 18 (17.1 %) patients, due to peritonitis — 8 (7.6 %), due to recurrent colonic bleeding — 3 (2.9 %) patients. The death rate was 13.8 % (n = 4). In the delayed order after successful conservative therapy, 70 (66.7 %) patients underwent surgical treatment in the surgical and oncology departments. Postoperative mortality was 1.4 % (n = 1).Conclusion. The complex of conservative measures, which allows avoiding emergency surgical intervention at the urgent stage of treatment, is the basis for carrying out a full-fledged surgical intervention in a delayed procedure in a specialized hospital, observing the principles of oncological radicalism.Цель исследования — оценка возможности консервативного лечения больных с осложнениями колоректального рака. Материалы и методы. Исследование обобщает результаты лечения 105 больных с осложнениями колоректального рака, пролеченных на базе Окружной клинической больницы г. Сургута за период 2012—2017 гг. В их числе 86 (81,9 %) пациентов с острой обтурационной кишечной непроходимостью, 11 (10,5 %) — с кровотечением из опухоли толстой кишки, 8 (7,6 %) — с гнойно-септическими осложнениями рака толстой кишки.Результаты. Комплекс консервативных мероприятий, включающих стентирование толстой кишки, обеспечил восстановление пассажа по пищеварительному тракту у 79,1 % пациентов, что позволило подготовить их к выполнению хирургического вмешательства, тем самым уменьшив риск развития осложнений. В экстренном порядке были оперированы 29 (27,6 %) пациентов: в связи с отсутствием эффекта от консервативной терапии при острой кишечной непроходимости — 18 (17,1 %), в связи с перитонитом — 8 (7,6 %), в связи с рецидивом толстокишечного кровотечения — 3 (2,9 %). Частота летальных исходов составила 13,8 % (п = 4). В отсроченном порядке после успешной консервативной терапии 70 (66,7 %) больных подвергнуты хирургическому лечению в условиях хирургического и онкологического отделений. Послеоперационная летальность составила 1,4% (п = 1).Выводы. Комплекс консервативных мероприятий, позволяющий избежать экстренного хирургического вмешательства на ургентном этапе лечения, обеспечивает возможность проведения полноценного хирургического вмешательства в отсроченном порядке в специализированном стационаре с соблюдением принципов онкологического радикализма

The role of conservative therapy in the treatment of complicated colorectal cancer

Objective: to evaluate the possibilities of conservative treatment of patients with complications of colorectal cancer.Materials and methods. The study included the results of treatment of 105 patients with complications of colorectal cancer treated on the basis of the District Clinical Hospital of Surgut for the period 2012—2017. Of these, 86 (81.9 %) patients with acute obstructive intestinal obstruction, 11 (10.5 %) patients with bleeding from colon tumors, and 8 (7.6 %) patients with purulent-septic complications of colon cancer.Results. The complex of conservative measures, including colon stenting, provides restoration of the passage through the digestive tract in 79.1 % of patients, which allows preparing the patient to perform surgery, thereby reducing the risk of complications. Twenty-eight (27.6 %) patients were operated on an emergency basis: due to the lack of effect from conservative therapy for acute intestinal obstruction — 18 (17.1 %) patients, due to peritonitis — 8 (7.6 %), due to recurrent colonic bleeding — 3 (2.9 %) patients. The death rate was 13.8 % (n = 4). In the delayed order after successful conservative therapy, 70 (66.7 %) patients underwent surgical treatment in the surgical and oncology departments. Postoperative mortality was 1.4 % (n = 1).Conclusion. The complex of conservative measures, which allows avoiding emergency surgical intervention at the urgent stage of treatment, is the basis for carrying out a full-fledged surgical intervention in a delayed procedure in a specialized hospital, observing the principles of oncological radicalism

Radiation study techniques in diagnosing the causes of opisthorchiasis-induced obstructive jaundice

Objective: to analyze the diagnostic value of radiation techniques in patients with opisthorchiasis-induced obstructive jaundice and to determine the types of bile duct (BD) changes characteristic of this disease.Subjects and methods. The investigation enrolled 103 patients with chronic opisthorchiasis complicated by obstructive jaundice. For BD visualization, the investigators used radiation diagnostic methods, such as ultrasonography (USG), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP); their efficiency was evaluated.Results. ERCP and MRCP could identify 5 types of BD architectonics in opisthorchiasis-induced obstructive jaundice. The sensitivity, specificity, and overall accuracy of MRCP in diagnosing opisthorchiasis-induced sclerotic changes were 98.1, 87.5, and 96.8%, respectively.Conclusion. Among instrumental methods for diagnosing sclerotic BD changes in prolonged opisthorchiasis invasion, it is preferable to use MRCP, which is determined by its high informative value. Five types of cholangioarchitectonics are detectable in chronic opisthorchiasis complicated by obstructive jaundice

Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit.

This is the peer reviewed version of the following article: group, T. E. S. o. C. c. (2018). "Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit." Colorectal Disease 20(S6): 47-57., which has been published in final form at https://doi.org/10.1111/codi.1437. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsINTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

Aim: The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method: An online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results: Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions: Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.A

The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection