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One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

In oncosurgery esophago-intestinal anastomotic leak as well as defects of the abdominal segment of the esophagus are serious complications associated with prolonged hospital stay and increased mortality rate. A choice of management tactics for each patient is individual. Treatment of esophageal anastomotic leak without separation provides the best result by reducing the time of rehabilitation, improving the quality of life and reducing mortality. Conservative treatment requires an adequate drainage when conducting enteral feeding and adequate antibiotic therapy. The indications for separation of the anastomosis include a large defect size, necrosis of the graft uncontrolled purulent-septic complications and a failure of conservative therapy. In recent decades a number of methods for endoscopic treatment of anastomotic leaks in the gastrointestinal tract have been elaborated, including the use of adhesive agents, self-expanding stents, clipping, and endoscopic vacuum system. These methods have several advantages over surgical and conservative management. Despite the accumulated experience, at present there is no single systemic approach to the use of endoscopic methods for closure of defects of anastomosis as well as defects of the abdominal segment of the esophagus. This is mainly due to a relatively small number of publications. One of the promising methods for endoscopic treatment of anastomotic leak is currently the Endoscopic Vacuum System (EndoVAC therapy). The article provides the clinical case of a patient with stomach cancer who was given transperitoneal gastrectomy with D2-lymphadenectomy which was complicated by a defect in the abdominal segment of the esophagus with peritonitis. To treat those complications relaparotomy, sanitation and drainage of the abdominal cavity was performed. In order to achieve closure of the fistula more quickly the vacuum system was used resulting in a marked decrease in fluid exudation, which in turn contributed to closure of the fistula.

Background. The problem of development of postoperative complications after operations on the organs of the gastrointestinal tact is extremely important. Failure of intestinal suture, formed in the presence of peritonitis develops from 2.8 to 32 % of patients. Aim. To improve immediate outcomes in the formation of a small intestine anastomosis in conditions of purulent peritonitis. Materials and methods. We conducted immunohistochemical examination of biopsy specimens of the small intestine of 20 patients died of peritonitis and compared the area of the vascular bed in different types of intestinal wall section. The experimental operations were performed in 100 Wistar rats. On the background of established models of peritonitis we performed different variants of small bowel anastomosis, including one with the use of photodynamic therapy. On the 6th day after the surgery, animals were sacrificed, and histological examination of the anastomoses was conducted. Results. Suture strip in the section of the small intestine made at the angle of 60° is supplied substantially better than in the section made at the angle of 90°. The experiment confirmed that the suggested method of anastomosis showed the best results. Conclusion. When one forms the "end-to-end" anastomosis in the small intestine in conditions of purulent peritonitis, it is reasonable to cross the intestinal wall at the angle of 60° and to perform photodynamic therapy on the formed anastomosis.

Sufficient length, as well as an adequacy of the blood supply to the distal part of the relegated colon in the formation of primary anastomosis are major intraoperative factors that can reduce the number of anastomotic leak in case of colon resections. Intraoperative fluorescence angiography allows you to assess an adequacy of the blood supply. It is easily feasible and reproducible technique. In this paper we publish our first experience of using this technique in 7 patients. In 1 of them intraoperative surgical tactics was changed after the study. Further developments in this direction are necessary in order to evaluate clinical significance of intraoperative fluorescence angiography in perfusion objectification during surgical operations on the colon.

The regularity of the splenic flexure mobilization during operations for rectal cancer is called in question. To assess if the splenic flexure mobilization during rectum resection has an impact on early postoperative complications rate, mortality and the number of lymph nodes examined. Prospective comparative study. 940 patients underwent a selective surgery for colorectal adenocarcinoma T1-4N0-2M0-1 during 2003-2014. Patients were divided into two groups: with the splenic flexure mobilization (n = 359), and without splenic flexure mobilization (n = 581). The early postoperative complications rate did not have statistically significant difference. Postoperative mortality had statistically insignificant difference (1,1% vs. 2,9%, p = 0.06). The number of examined lymph nodes increases if the splenic flexure mobilization is performed (13±7,3 vs. 10,6 ± 6,6, p

Colorectal anastomosis failure is one of the serious complications following abdominoperineal resection of the rectum, accounting for approximately 40 % of cases. Mortality rate in patients with colorectal anastomosis was reported to be 39 % and above 90 % in cases with anastomosis located in the abdomen. The literature analysis showed the importance of the problem of colorectal anastomosis failure, thus dictating the necessity of searching for the new methods of prevention and treatment for this serious complication. The aim of the study was to analyze the literature on the risk factors for colorectal anastomosis. The main factor influencing anastomotic leakage is the height of the anastomosis above the anal verge. The authors’ data were often contradictory.

Objective: To compare the short-term results after left-sided laparoscopic colectomy with transanal and transabdominal specimen extraction., Material Land Methods: We selected 998 appropriate manuscripts and subsequently excluded 995 ones due to exclusion criteria. Thus, the meta-analysis was based on 3 randomized trials in accordance with PRISMA recommendations., Results: A total of 353 patients were enrolled in meta-analysis including 169 resections with transanal specimen extraction and 184 surgeries with transabdominal extraction. Overall risk of postoperative complications (OR=0.60; 95% CI 0.31-1.14; p =0.12) including anastomotic leakage (OR=1.83; 95% CI 0.43-7.89; p =0.42) was similar in both groups. At the same time, severity of pain syndrome (mean difference = -2.35; 95% CI -2.51-2.19), time to the first flatus discharge (mean difference = -0.92; 95% CI -0.99-0.85) and postoperative hospital stay (mean difference = -1.5; 95% CI -2.03-0.98) were significantly lower in the group of transanal extraction ( p <0.00001)., Conclusion: Transanal specimen extraction in left-sided laparoscopic colectomy does not increase overall risk of postoperative complications. In addition, the NOSE technique has some advantages in short-term results compared to procedures with transabdominal specimen extraction.

Objective: To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease., Material and Methods: A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12)., Results: Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% ( n =10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery., Conclusion: In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.

Objective: To determine the training period for imposing hepaticojejunostomy for bile duct repair., Material and Methods: Reconstructive surgery on the bile ducts was performed in 53 patients. We analyzed the learning curves based on the incidence of anastomotic leakage after hepaticojejunostomy., Results: The learning curve has a downward nature. The number of anastomotic failures decreases by 2 times after 42 procedures. Surgeon had to perform 39-42 operations to reduce the incidence of this complication., Conclusion: Treatment of patients with iatrogenic intersections of the bile ducts should be provided in appropriate hospitals.

An experience with 60 operated patients allows introduction of accuracy in the idea of possibility to use the compromised with different diseases and surgical procedures stomach in plasty of the esophagus. Technical specific features of forming the transplant are developed. Practicability of esophageal plasty with the small bowel using the loop of the bowel involved in digestive anastomoses is shown. In nonstandard situations the success of surgery is determined by an individual choice of plastic material, using reconstructive vascular surgery and rational method of placing the transplant.