Experience of Two-Stage Treatment of Rectal Fistulas Using Low-Thrombin Fibrin Glue “Kriofit”

Аim: to improve the results of treatment of patients with rectal fistula.Materials and methods. Twenty-eight patients with rectal fistulas were included in the study — 20 (71,4 %) men and 8 (28,6 %) women, average age — 40 (24–68) years. Based on examination and transrectal ultrasound data, 13 (46.4 %) patients had intrasphincteric fistulas and 15 (53.6 %) had transsphincteric fistulas. All patients underwent prehospital transrectal ultrasound and sphincterometry to assess the functional state of the anal sphincter, and the SF-36 quality of life questionnaire and Wexner scale assessing the functional status of the anal sphincter were analyzed. All patients, included in the study, had straight fistulous passage, without collections and significant scarring of the anal canal. Patients underwent two-stage surgical treatment using low-thrombin fibrin glue “Kriofit”. Follow-up of the patients was carried out on days 7, 14, 21 and included collection of complaints, examination of the perianal area, finger examination of the rectum. In the postoperative period, the intensity of pain syndrome was assessed using the visual analog scale of pain. On days 30 and 90 control transrectal ultrasound, sphincterometry, assessment of Wexner scale and patients' quality of life by SF-36 questionnaire on days 7 and 30 after the operation were performed. Results. There were no intraoperative and early postoperative complications among patients. The average bed-day was 6.8 (5–11) days. The follow-up periods ranged from 1 to 42 months. Disease recurrences were diagnosed in 3 (10.7 %) patients. According to the sphincterometry data, no anal holding dysfunction was detected in any of 28 patients.Conclusion. The results of our study have shown that the division of preliminary surgical treatment of the fistulous passage followed by local anti-inflammatory treatment and filling of the wound canal with two-component fibrin glue with low thrombin content “Kriofit” into two stages effectively increases the results of the proposed technique. The use of fibrin glue as a sphincter-preserving technique makes it possible to exclude the development of postoperative anal incontinence, and new technologies and materials reduce the risk of disease recurrence

Ilaser Submucous Destruction in the Treatment of Hemorrhoids

Aim: to improve the results of treatment in patients with hemorrhoids of the 2nd and 3rd stages.Materials and methods. The prospective study included 60 patients with hemorrhoids of the 2nd and 3rd stages. All patients underwent destruction of internal hemorrhoids with a fiber laser with a diode pump with a wavelength of 1940 nm. The technique is based on the effect of laser energy on the cavernous tissue of the internal hemorrhoidal node and on the terminal branches of the upper rectal artery. The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. In 3 patients (5 %) intraoperative hemorrhage developed. In the early postoperative period, 5 patients (8.3 %) had 7 complications: 5 cases of thrombosis of the external hemorrhoidal node and 2 — of acute urinary retention. The conducted single-factor analysis showed the dependence of the development of complications on the energy transferred to each hemorrhoidal node and its total amount for the entire operation. In terms of up to 6 months, there were no signs of a return of the disease in any case (hemorrhoidal prolapse and blood discharge). The detected hemorrhoids before the operation, a month after the operation, were not visualized, which persisted after 6 months. The performed transrectal ultrasound examination with spectral-wave dopplerography for up to 6 months allowed to diagnose a persistent decrease in blood flow along the terminal branches of the upper rectal artery compared with preoperative values. When performed sphincterometry, there was no change in the parameters of the anal sphincter function compared to preoperative parameters.Conclusion. The proposed method applying a fiber laser with a diode pump with a wavelength of 1940 nm makes it possible to affect transdermally the internal hemorrhoidal node without damaging the mucosa of the anal canal. The absence of postoperative wounds in the anal canal leads to a decrease in pain syndrome, and by day 7 there are no clinical manifestations of hemorrhoids. The method of laser destruction of internal hemorrhoids can be used in outpatient conditions and can improve the quality of life of patients in the early postoperative period

The course and clinical manifestations of Peutz–Jeghers syndrome in the Russian population

Background. PeutzJeghers syndrome (PJS) is a rare hereditary syndrome characterized by the growth of hamartomatous polyps in the gastrointestinal tract, perioral pigmentation and an increased risk of malignant neoplasms. The syndrome is caused by a pathogenic variant in the STK11 gene. Aim. To assess the clinical picture and treatment of Russian patients with PJS. Materials and methods. A retrospective analysis of 30 patients from 25 families with an established diagnosis of PJS who were in the Ryzikh State Scientific Center for Coloproctology from 2011 to 2021 was carried out. All patients underwent instrumental examination, including esophagogastroduodenoscopy, colonoscopy, X-ray examination of the small intestine/CT-enterography, in the absence of invaginates video capsule endoscopy, as well as molecular genetic examination for the presence of pathogenic variants in the STK11 gene. All removed polyps were subjected to the histological examination. Results. The analysis of the clinical picture allowed us to establish the following data: the first complaints in patients were noted in childhood and adolescence, while the median age was 11 [7; 19] (0.524) years; pathogenic variants in the STK11 gene were identified in 26 (87%) cases, among which 10 were described for the first time; during the initial examination, polyps in the small intestine were detected in all 30 (100%) patients, in the stomach in 23/30 (77%) patients, and in the colon in 21/30 (70%); with an age, an increase in the number of polyps in all parts of the gastrointestinal tract was noted; before the diagnosis operations were performed urgently for intestinal obstruction; after the diagnosis of PJS, when polyps were detected in the gastrointestinal tract, endoscopic polypectomies were performed; if endoscopic removal of hamartomatous polyps was impossible, patients were operated as planned; malignant diseases of the predominantly reproductive system were detected in 8/30 (27%) patients. The median age of cancer detection was 52 [31; 52] (1759) years. Conclusion. Russian patients with PJS have population-specific features in the clinical picture of the course of the disease, which dictates the need to develop their own recommendations for monitoring and treatment of such patients

The Opportunity of Using Diode Laser with the Length of 1940 nm in the Treatment of Hemorrhoids

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis

Modern composition and distribution of alien fish species in the water bodies of the Krasnoyarsk Territory

Текст статьи не публикуется в открытом доступе в соответствии с политикой журнала.This paper presents the information on the history of appearance, modern composition, and distribution of fish species that have been introduced by man or have settled independently in the water bodies of the Krasnoyarsk Territory since the early 20th century. It is shown that the fish fauna composition has expanded mainly in the basin of the upper and middle Yenisei as well as in the basin of the Chulym that is a right tributary of the Ob; the fish fauna of the Pyasina and Khatanga rivers that are beyond the Arctic Circle has remained unchanged. Eleven fish species and two subspecies are new for the region; among them, common bream and sunbleak have largely expanded their range in the Yenisei and Chulym basins; pike perch, Amur sleeper, and bleak have enlarged their range only in the Chulym basin. The spread of other species is limited by the regions of their artificial stocking. Peled that is common for the northern regions of the territory was resettled in the Krasnoyarsk Reservoir; the status of Prussian carp that was introduced from the Amur River and degree of its assimilation with the local populations of this species are not clear

Modern composition and distribution of alien fish species in the water bodies of the Krasnoyarsk Territory

Текст статьи не публикуется в открытом доступе в соответствии с политикой журнала.This paper presents the information on the history of appearance, modern composition, and distribution of fish species that have been introduced by man or have settled independently in the water bodies of the Krasnoyarsk Territory since the early 20th century. It is shown that the fish fauna composition has expanded mainly in the basin of the upper and middle Yenisei as well as in the basin of the Chulym that is a right tributary of the Ob; the fish fauna of the Pyasina and Khatanga rivers that are beyond the Arctic Circle has remained unchanged. Eleven fish species and two subspecies are new for the region; among them, common bream and sunbleak have largely expanded their range in the Yenisei and Chulym basins; pike perch, Amur sleeper, and bleak have enlarged their range only in the Chulym basin. The spread of other species is limited by the regions of their artificial stocking. Peled that is common for the northern regions of the territory was resettled in the Krasnoyarsk Reservoir; the status of Prussian carp that was introduced from the Amur River and degree of its assimilation with the local populations of this species are not clear

Possibilities for the Application of Low-Temperature Argon Plasma in the Treatment of Postoperative and Long-Term Non-Healing Wounds

Aim. To review available information on the use of low-temperature argon plasma in the treatment of postoperative and long-term non-healing wounds.General findings. Low-temperature argon plasma is an ionised gas, one of the four classical aggregate states of matter. Its therapeutic effect is achieved by means of the gas-dynamic effect, i.e. an argon flow with a high heat content and wide-spectrum recombination radiation — from the vacuum ultraviolet region to the near infrared range, as well as by means of the pronounced catalytic properties of gaseous argon, which is important for a number of biochemical reactions. Low-temperature argon plasma has a pronounced antibacterial effect. In a number of studies, the wound healing effect of low-temperature argon plasma was demonstrated.Conclusion. The use of low-temperature argon plasma can reduce the time of wound healing, the titre of clinically significant microorganisms and the time spent by patients in hospital. In addition, the use of low-temperature argon plasma can improve patients’ quality of life in the postoperative period

Cellular Reconstruction of the Rectal Mucosa during surgical Treatment of Familial Adenomatosis of the Colon: 12 Years after the First Experience of Introduction into Clinical Practice

Aim. To study long-term results of surgical treatment of patients with familial adenomatous polyposis (FAP) with the cell reconstruction of the rectal mucosa.Materials and methods. 57 FAP patients were subjected to treatment, which involved colproctectomy, the preservation of the lower rectal ampulla, mucosectomy and the reconstruction of the mucosa by cell transplantation. Endoscopic monitoring was carried out, with the endoscopic observation covering the period of 19–120 months (median — 44.3 months). Morphological and immunohistochemical studies were conducted. The long-term functional results of treatment (anorectal manometry (profilometry)) were studied. The patients were surveyed using the SF-36 questionnaire to monitor the quality of their life.Results. Our results show that the use of cell transplantation leads to the reconstruction of the rectal mucosa over a fairly short time: in 44/57 (77.2 %) patients, the endoscopic picture corresponded to the unchanged rectal mucosa 4 weeks after the surgery. In 13/57 (22.8 %) patients, a complete mucosal reconstruction was achieved 8–12 weeks after the surgery. The absence of polyp growth in the preserved part of the rectum was observed. Late complications developed only in 5 (9.4 %) patients. Good functional results (acceptable frequency of defecation, lack of signs of anal incontinence and nocturnal defecation) were observed in 48/53 (90.6 %) patients. The quality of life was at a fairly high level in 90.6 % of patients.Conclusion. The proposed method of FAP treatment allowed the immediate and long-term treatment results to be improved significantly

Options of biological substances application in rectal fistulas treatment (Review of the literature)

Aim of review. To present literature data of the treatment of incomplete rectal fistulas with application of biological substances. Summary. Treatment of rectal fistulas remains burning issue in coloproctology due to unsatisfactory results of surgery resulting in high relapse rate, usually regardless of applied surgical method and high risk of severe complications as anal sphincter incompetence. This is why development of sparing methods of rectal fistula treatment that will allow to decrease intraoperative trauma of the anal sphincter at minimal risk of disease recurrence and, therefore, to prevent development of sphincter incompetence is important. Application of biological materials in rectal fistulas treatment result in reduction of the wound size, accelerates reparative processes and decreases degree of traumatization. Minimization of surgical impact on the anal sphincter allows repetitive application of biological materials up to the achievement of positive effect. Conclusion. Application of biological materials at sphincter-preserving technique provides decreased risk of development of postoperative anal sphincter incompetence