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Khirurgiia (Mosk) ; (9): 77-84, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480459


OBJECTIVE: To compare early (resection quality, complication rate, surgery time) and long-term (recurrence rate) outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection. MATERIAL AND METHODS: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Data were analyzed using the Rewiew Manager 5.3 software. RESULTS: The study included 8 manuscripts including 6 retrospective trials, 1 case-control and only 1 prospective study. These studies comprised the results of endoscopic resection of 1989 colonic tumors (EMR - 748, ESD - 1241). ESD is associated with higher incidence of en-bloc resection (OR 0.13; 95% CI 0.03 0.49; p=0.003) and R0 resection (OR 0.23; 95% CI 0.05 1.02; p=0.05) compared to EMR. Local recurrence rate is 13 times higher after EMR compared to ESD (OR 13.94; 95% CI 6.3 30.8; p=0.00001). However, ESD is followed by 4 times higher risk of colon wall perforation (OR 0.25; 95% CI 0.08 0.81; p=0.02). CONCLUSION: ESD is more advisable regarding resection quality compared to EMR. However, higher incidence of perforations, surgery time and technical features of ESD do not allow us to unambiguously interpret the results of our meta-analysis and determine the optimal surgical approach.

Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Humanos , Mucosa Intestinal/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
Khirurgiia (Mosk) ; (7): 5-11, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270187


OBJECTIVE: To evaluate the early and long-term outcomes of rectovaginal fistula closure with vaginal rectangular flap. MATERIAL AND METHODS: There were 61 patients with rectovaginal fistula for the period 2012-2020. Median age of patients was 35 years [31; 48]. Postpartum fictula was observed in 27 (44.2%) cases, postoperative - 10 (16.4%) patients, inflammatory - 15 (24.6%) patients, other causes - 9 (14.8%) patients. Disease recurrence occurred in 29 (47.5%) patients. RESULTS: Median follow-up period was 36.2 [6; 64] months. Postoperative recurrence of rectovaginal fistula occurred in 19 (31.1%) patients. Length of hospital-stay ranged from 3 to 36 days (median 14 [12; 16]). We analyzed the relationship between the risk of disease recurrence and various factors, including etiology of rectovaginal fistula, localization and diameter of the fistula, intraoperative cautery, previous surgeries and preventive colostomy. CONCLUSION: Vaginal rectangular flap is effective for rectovaginal fistula. Multivariate analysis confirmed two significant risk factors of postoperative recurrence: diameter of fistula over 5 mm and its localization in the rectum above the upper border of surgical anal canal (more than 7 mm from the dentate line).

Fístula Retovaginal , Retalhos Cirúrgicos , Adulto , Canal Anal , Feminino , Humanos , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Reto/cirurgia , Resultado do Tratamento
Khirurgiia (Mosk) ; (8. Vyp. 2): 30-41, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30199049


AIM: To identify the most effective management of colorectal anastomosis failure via analysis of available literature sources. RESULTS: Systematic review included 20 original trials. Effectiveness of redo interventions for colorectal anastomosis failure including open, laparoscopic, minimally invasive techniques (transanal drainage, endoscopic vacuum therapy, endoscopic drainage) was described. Anastomotic failure rate was 6.5%. Medication was effective in 57% (95% CI 34-77%) of cases. Redo open surgery was applied in 43% (95% CI 23-66%) of patients. Postoperative mortality was 21-27%. Redo laparoscopic procedure was performed in 61% (95% CI 50-70%) of cases for anastomotic failure after previous laparoscopy, incidence of conversion was 12% (95% CI 4-28%). Transanal drainage was effective in 85% (95% CI 61-94%) of cases, endoscopic vacuum therapy - in 82% (95% CI 74-87%), healing of anastomosis without need for colostomy was achieved in 16% (95% CI 9-26%) of cases. Endoscopic clipping for colorectal anastomotic defect was effective in 73.3-77% of cases. CONCLUSION: Redo surgery for anastomotic failure is associated with advanced mortality and need for permanent colostomy. Laparoscopic approach reduces incidence of complications after redo surgery and followed by better functional outcomes. Minimally invasive procedures are advisable for colorectal anastomosis failure without need for redo surgery. However, effectiveness of these methods is controversial due to few reports and no comparative trials.

Fístula Anastomótica/cirurgia , Neoplasias Colorretais/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/mortalidade , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Humanos , Laparoscopia/métodos , Laparoscopia/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Complicações Pós-Operatórias/mortalidade , Reto , Reoperação/mortalidade