[Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer]. / Issledovanie morfologicheskikh prediktorov vodno-elektrolitnykh narushenii u patsientov so sformirovannoi preventivnoi ileostomoi pri rezektsii pryamoi kishki po povodu raka.

OBJECTIVE: To analyze morphological changes in wall of functioning and non-functioning small intestine in patients with preventive ileostomy and to determine histological predictors of water-electrolyte disorders. MATERIAL AND METHODS: We prospectively analyzed 57 patients >18 years old who underwent rectal resection with preventive ileostomy between January 2022 and November 2023. Anthropometric data included gender, age, body mass index, ECOG and ASA classes. Complications associated with large losses through ileostomy were water-electrolyte disorders, dehydration and acute renal failure with repeated hospitalization. Morphological analysis implied intraoperative full-layer biopsy of small intestine on anterior abdominal wall (ileostomy). Intraoperative biopsy of efferent and afferent loops was also carried out. Tissue samples were examined by light microscopy. We analyzed mean height of mucous membrane villi and depth of crypts, as well as their ratio. Fibrosis and swelling of submucosa were evaluated too. The results were analyzed in the SPSS Statistics 20 software. RESULTS: Mean height of intestinal villi <465 microns (p=0.028), ratio of their height to crypt depth <4.38 (p=0.034) and submucosal fibrosis (p=0.031) significantly affected malabsorption and readmission of patients. The risk of readmission was 11.5 and 5.5 times higher in univariate analysis. Multivariate analysis revealed in-hospital dehydration with resumption of infusion therapy as a predictor of readmission (p=0.046). CONCLUSION: Ileostomy is a certain stress for the patient's body. Not every patient is able for adaptation. One of the adaptation mechanisms is hypertrophy of mucous membrane villi involved in digestion. This mechanism is less pronounced in patients with repeated hospitalizations. Preoperative morphological examination of ileum mucosa may be an additional objective predictor of possible complications of preventive ileostomy.

[Recanalization of colon in the treatment of patients with acute malignant obstructive colonic obstruction]. / Metody rekanalizatsii tolstoi kishki v lechenii bol'nykh ostroi obturatsionnoi tolstokishechnoi neprokhodimost'yu zlokachestvennogo geneza.

OBJECTIVE: To analyze available literature data on the methods of colon recanalization in patients with acute malignant obstructive colonic obstruction. MATERIAL AND METHODS: We retrospectively analyzed literature data on the treatment of acute neoplastic colonic obstruction. RESULTS: We reviewed available national and foreign literature data on various methods of colon recanalization including various modern and hybrid techniques. CONCLUSION: Methods of colon recanalization with subsequent stenting are the most optimal for preoperative decompression of colon. These measures are effective and allow postponing radical surgery or avoiding it altogether without worsening the prognosis of the underlying pathology. However, there is a small amount of literature data on modern hybrid methods of recanalization.

[Preoperative biliary drainage for malignant biliary obstruction: to drain or not to drain? And if drain, in what way?] / Predoperatsionnaya biliarnaya dekompressiya pri opukholevoi zheltukhe: drenirovat' ili net? I esli drenirovat', to kakim sposobom?

On the basis of the conducted literary search, a number of conclusions can be drawn. When performing preoperative biliary drainage (PBD), it is necessary to have a clear understanding: why is this procedure performed (severe liver failure, cholangitis, long preoperative preparation is required due to comorbid status, neoadjuvant chemotherapy is necessary, etc.)? Routine use of PBD is impractical. In the presence of indications for PBB in perihilar cholangiocarcinoma, percutaneous decompression is preferable, in periampullary tumors, endoscopic. Moreover, both methods can be alternative (for example, in case of technical failure of the first priority). There is also no convincing evidence of the superiority of metal stents over plastic ones for PBD (except in cases of long-term preoperative preparation or neoadjuvate treatment) for periampular tumors. To date, a decrease in overall survival and a higher incidence of implantation metastases have not been proven when using the antegrade PBD method. Large multicenter studies are required with differentiation of patients according to the nosological principle in order to more accurately understand the place of each method, as well as to determine clear indications for PBD and those clinical situations when its implementation is impractical.