[Loop colostomy as a risk factor of postoperative ileus in elective colorectal cancer surgery]. / Petlevaya stoma kak faktor riska razvitiya posleoperatsionnogo ileusa v planovoi khirurgii kolorektal'nogo raka.

OBJECTIVE: To identify risk factors of postoperative ileus (POI) in elective colorectal cancer (CRC) surgery. MATERIAL AND METHODS: A non-randomized retrospective study included 220 patients who underwent elective surgery for colorectal tumors. The indication for surgery was CRC stage 0-IV in 213 (96.8%) cases, villous adenoma in 7 cases (3.2%). Risk factors of POI defined in univariate analysis were included into multivariate analysis. Logistic regression was used in this case. RESULTS: Risk factors of POI were male sex (p=0.04), multifocal CRC (p=0.03), intraoperative transfusion (p=0.005), postoperative transfusion (p=0.035), left-sided hemicolectomy (p=0.01), colostomy (p=0.02), loop transversostomy (p=0.003), loop colostomy (p=0.02). According to logistic regression, independent risk factors of POI were male sex (p=0.015), left-sided hemicolectomy (p=0.004), intraoperative transfusion p=0.002), loop transversostomy (p=0.019). CONCLUSION: Independent risk factors of POI in elective colorectal cancer surgery were male sex, left-sided hemicolectomy, intraoperative transfusion and loop transversostomy.

[Selection of the method for surgical treatment of pilonidal disease without abscess formation]. / Vybor metoda khirurgicheskogo lecheniia pilonidal'noi bolezni bez abstsedirovaniia.

The problem of the treatment of pilonidal disease, affecting 5% of the adult working-age population and occupying the fourth place in the structure of coloproctological diseases after hemorrhoids, paraproctitis and anal fissure, is extremely relevant today. The history of the choice of approaches to surgical treatment has almost 2 centuries. Based on different theories of etiopathogenesis, various methods of surgical treatment have been proposed. However, the results of treatment leave much to be desired. To date, there is no 'gold standard' of surgical treatment of pilonidal disease, nor any standardization in this matter. The aim of the investigation is to compare the two, in our opinion, the most versatile methods of surgical treatment of the nosology under consideration, which allow to achieve a good cosmetic result in cases of any complexity without long-term disability - Limberg flap and Bascom II plastics. Indicators such as the duration of the intervention, the level of postoperative pain, postoperative complications, the duration of disability, patient satisfaction with the cosmetic result, relapses were evaluated. As a result, patients after performing Bascom II noted less postoperative pain and were more satisfied with the cosmetic result. A significantly lower percentage of relapses was noted in the group with Limberg flap. The percentage of complications and terms of disability was not significantly different.

[Assessment of the efficiency and safety of the modified combined approach for laparoscopic splenic flexure mobilization]. / Otsenka éffektivnosti modifitsirovannogo kombinirovannogo dostupa pri laparoskopicheskoi mobilizatsii selezenochnogo izgiba obodochnoi kishki.

AIM: To evaluate the efficacy and safety of the proposed modified combined approach for laparoscopic splenic flexure mobilization (SFM). MATERIAL AND METHODS: A multicenter non-randomized comparative study was conducted. The main group consisted of 12 patients who underwent laparoscopic modified combined SFM from December 2018 to May 2019, the control group consisted of 12 patients who underwent laparoscopic traditional combined SFM from 2013 to 2018. The following aspects were evaluated: total duration of the operation, duration of the SFM, blood loss, rate of conversions, intraoperative complications, postoperative complications, duration of the postoperative period. RESULTS: Significant differences were obtained for the average duration of the SFM. The duration of the procedure was calculated during watching a video of operation. The average duration of the SFM in the main group was 37.4±12.2 min, in the control group 59.5±19.1 min (p=0.03). The average blood loss in the main group was 52.5±12.3 ml, in the control group - 115.6±20.7 ml (p=0.02). In the main group there were no intraoperative complications, while in the comparison group 1 case of the spleen damage was noted, requiring conversion, and 1 case of the pancreas damage. These differences are not significant due to the small sample. CONCLUSION: The use of the proposed modified combined approach for the laparoscopic SFM significantly reduces the duration of the operation and is accompanied by a decrease in the frequency of intraoperative complications. However, further randomized studies with a larger sample are needed.

[Current directions in professional training of surgeon]. / Sovremennye napravleniia professional'noi podgotovki vracha-khirurga.

AIM: To develop 'Cadaveric Course' of operative surgery for severe combined trauma for students, surgical residents, postgraduate students of medical universities and to compare its effectiveness with other approaches. MATERIAL AND METHODS: 'Cadaveric course' program of operative surgery for severe combined trauma consisted of four stages. The first stage is theoretical course (2 weeks), the second stage - students' work in cadaveric operating theatre with instructors (5 weeks), the third stage - their independent work in 'cadaveric operating theatre (10 weeks), the fourth stage - analysis of the results and their comparison with those of 5 2-year residents (control group). RESULTS: There were significant differences in practical skills between students. Mean time of surgery and expert assessment score were 32.0±9.5 min and 4.6±0.5 in the main group, respectively, in the control group - 46.0±7.5 min and 3.6±0.5 scores, respectively (p=0.03 and p=0.02). Theoretical background was similar in both groups (p>0.05). CONCLUSION: Research has opened new opportunities to introduce 'cadaveric course' into educational process, to analyze its outcomes and further improvement.

[Specialist's training for laparoscopic surgery in Wet-lab educational operating theatre]. / Sistema podgotovki spetsialista po laparoskopicheskoi khirurgii v uchebnoi operatsionnoi Wet-lab.

AIM: To develop system for students training in laparoscopic surgery by using of Wet-lab educational operating theatre. MATERIAL AND METHODS: We have launched laparoscopic surgery teaching program for students of Ryazan State Medical University. This system includes several stages. At the first stage professional selection was carried out on 'dry' laparoscopic simulators among III-IV-year students of medical faculty. So, 10 people were selected. The second stage included theoretical and practical parts consisting of development of basic laparoscopic skills on 'dry' simulators. 5 students who scored the maximum points were admitted to the next stage. The third stage is working in Wet-lab operating theatre with a mentor. There were 10 sessions on 10 laboratory pigs. Final stage of our study compares two groups of participants: main group - 5 students who underwent above-described program and control group of 5 residents without experience for laparoscopic operations. RESULTS: The participants of the main group had significantly higher OSATS score compared with another group (20 vs. 10; p<0.05). Movements effectiveness estimated by measuring of movements trajectory total length was also higher in main group than in control group (6 vs. 20; p<0.05). Experts' subjective assessment according to 10-point scale was also higher for students than for interns (9 vs. 5, p<0.05). Participants in the main group required significantly less time to complete the task compared with the control group (40 vs. 90 minutes, p<0.05). CONCLUSION: Our experience has shown that training system with Wet-lab operating theatre is effective for quick and efficient training of medical students in main laparoscopic procedures. In our opinion, introduction of students into 'advanced' surgery from early age will make it possible to get finally highly professional specialists.

[Treatment of rectal foreign bodies]. / Taktika lecheniya patsientov s inorodnymi telami pryamoi kishki.

AIM: to present the results of treatment of rectal foreign bodies. MATERIAL AND METHODS: 15-year outcomes of 112 patients with rectal foreign bodies were analyzed. RESULTS: Outpatient and hospital care were applied in 52 (46%) and 60 (54%) of cases respectively. Transanal removal was made in 97 (87%) patients including 28 (25%) cases of general anaesthesia. 14 (13%) patients underwent surgery. Colostomy was performed in 7 (6%) cases. We presented cases of foreign bodies removal through laparotomy, colotomy and SILS-assisted transanal approach. DISCUSSION: From clinical point of view foreign bodies should be first of all classified by their dimensions. Anamnesis and physical examination are very important. Abdominal X-ray survey is obligatory. Transanal removal under general anaesthesia is advisable if perforation is absent. If such procedure is impossible laparotomy is indicated. CONCLUSION: Algorithm of survey and treatment is presented.