[Rehabilitation of operated patients with diffuse polyposis of the large intestine]. / Reabilitatsiia operirovannykh bol'nykh diffuznym polipozom tolstoi kishki.r

In 1965 to 2000, the State Coloproctology Research Center operated on 584 patients for diffuse polyposis of the large intestine. A 18-year follow-up showed that metabolic disorders developed in 85% of cases due to the loss of large intestine that is important for maintaining homeostasis. The authors consider it necessary to continuously follow up the patients operated on for diffuse polyposis for timely diagnosis of occurring metabolic disorders and their correction. This approach to complex treatment of diffuse polyposis promotes social and working rehabilitation of patients operated on.

Results of a thirty-year study of familial adenomatous polyposis coli.

PURPOSE: This study was designed to estimate the efficiency of the various methods used to treat familial adenomatous polyposis coli. METHODS: Three hundred ninety patients (219 males) underwent surgery for familial adenomatous polyposis coli; postoperative follow-up was from 1 to 30 years. RESULTS: Coloproctectomy with preservation of the anal sphincter and coloproctectomy with ileoanal pull-through procedures resulted in development of anal canal cancer in 3 (4.1 percent) of 74 patients. Follow-up revealed development of cancer in the large bowel in 26 (10.7 percent) of 242 patients, in whom colectomy with preservation of various colonic segments was performed. CONCLUSIONS: The occurrence rate of cancer is not significantly related to patients' gender, age, length of preserved colonic segment, presence of cancer in the removed colonic segment, or postoperative follow-up period; however, presence of polyps in the colonic segments preserved during surgery significantly increased the risk of development of cancer at a later time.

[Effectiveness of preserving large intestinal segments in surgical treatment of proliferative diffuse polyposis]. / Effectivnost sokhraneniia segmentov tolstoi kishki pri khirurgicheskom lechenii proliferiruiushchei formy diffuznogo polipoza.

Among 390 patients who were operated on in the Research Institute of Proctology for the proliferative form of diffuse polyposis, 242 underwent various types of operations in which polyp-free segments of the large intestine were not resected. In the first 5 postoperative years all 242 patients were examined, in follow-up periods of 6 to 10 years 144 patients (59.5%), in periods of 11 to 15 years 88 patients (36.4%), in periods of 16 to 20 years 28 patients (11.6%), and after 21 years 8 patients (3.3%) were examined. Development of carcinoma in the preserved segments was encountered in 26 patients (10.7%), and intensive growth of polyps for which the preserved segment had to be removed was found in 5 patients (2.1%). There was no significant increase of the risk of carcinoma development in the preserved intestinal segments in patients who previously had a malignant tumor in the resected part of the large intestine. The development of carcinoma and intensive growth of polyps were encountered most frequently in patients in whom the distal parts of the large intestine were not removed during the operation. The obtained data are evidence of the validity of the choice of the volume of the operation based on the endeavor to preserve the polyp-free parts of the large intestine for rehabilitation of the patients.

[Comparative characteristics of various types of operations performed in treatment of diffuse colonic polyposis]. / Sravnitel'naia kharakteristika razlichnykh vidov operatsii, primeniaemykh pri lechenii diffuznogo polipoza tolstoi kishki.

Diffuse polyposis of the large intestine characterized by the development of multiple polyps in it and their subsequent malignant degeneration is one of the most severe disease of the gastrointestinal tract. That it must be treated by surgery needs no proof. However, the volume and the character of the surgical intervention on the large intestine is still a debatable problem. The article discusses the experience in the follow-up of 445 patients for periods of 12 months to 30 years after operation for diffuse polyposis. In 228 patients various segments of the large intestine which were free from polyps were not resected. During these follow-up periods malignant tumors developed in the preserved parts of the large intestine in 10.1% patients and intensive growth of polyps was encountered in 3.5% of patients. The frequency of carcinoma development depended significantly less on the length of the follow-up period and much more on the character of affection of the preserved parts of the large intestine with the polyps.

[Results of preservation of distal parts of the large intestine in the surgical treatment of diffuse polyposis]. / Rezultaty operatsii s sokhraneniem distalnykh otdelov tolstoi kishki pri diffuznom polipoze.

One hundred patients were examined in periods of one to 30 years after subtotal resection of the large intestine with the formation of an ileorectal or ileo-sigmoid anastomosis for diffuse polyposis with prevalence of proliferative processes. A malignant tumor developed in the preserved distal parts of the large intestine during this period in 19 (19%) persons. Such factors as the sex, age, duration of the postoperative follow-up period, the presence of a malignant tumor in the removed part, and the length of the functioning segment of the large intestine had no essential effect on the frequency of carcinoma. The presence of any number of polyps in the remaining part of the large intestine at the moment of the surgical intervention was the principal precondition for carcinoma development. The absence of polyps in it is a favorable factor for the survival of the operated on patients; in none of them did a malignant tumor develop in the preserved segment of the large intestine.

[The therapeutic procedure for desmoids in patients with diffuse polyposis of the large intestine]. / Lechebnaia taktika pri desmoidakh u bol'nykh diffuznym polipozom tolstoi kishki.

Desmoid was diagnosed in 54 out of 632 patients who had been operated on for diffuse polyposis. The age of patients with desmoid ranged from 18-61 years. Twenty of them had desmoid in the anterior abdominal wall whereas 30--in the small intestine mesentery or retroperitoneal space. Dissection was carried out in 14 out of 18 patients with anterior abdominal wall desmoid. Recurrence was registered in 6 patients. Dissection was attempted in 12 out of 26 patients with intraabdominal desmoid but radical procedure could be performed in 5 only. In a group of 4 patients with synchronous desmoid of both sites, both tumors were removed in one patient only whereas in the other 3--only anterior abdominal wall tumor could be dissected.