Maria A. Ignatenko

OBJECTIVE: the aim of this study is the effect of PRP application on the outcomes of chronic anal fissure treatment and to analyze the factors associated with the rate of anoderm defect epithelialization. PATIENTS AND METHODS: a single-center prospective randomized controlled trial (NCT07268261) was conducted from September 2023 to November 2025. We compared the outcomes of fissure excision (FE) combined with botulinum toxin type A (BTA) injection at a dose of 40 units and platelet-rich plasma injection (FE+BTA+PRP - study group) versus FE combined with BTA (FE+BTA - control group). After applying the exclusion criteria, 125 patients were included in the final analysis: 60 in the study group and 65 in the control group. Cellular composition of plasma was assessed using a hematology analyzer in 51 (85.0%) of 60 patients in the study group; among them, 29 patients underwent blood collection in two-component tubes (Subgroup A), and 22 patients underwent collection in single-component tubes (Subgroup B). The comparative analysis included assessment of wound epithelialization rate on 15, 30, 45 and 60 postoperative days, analgesic requirements, quality of life according to the SF-36 scale, platelet and leukocyte concentrations in PRP, as well as ROC analysis of the prognostic significance of the platelet profile. RESULTS: on the 60th day, the rate of postoperative wound healing was comparable in both groups, up to 43/60 (71.7%; 95% confidence interval [CI]: 58.6–82.5) cases in the FE+BTA+PRP group and 47/65 (72.3%; 95% CI: 59.8–82.7) cases in the FE+BTA group (p=0.936); on the 15th day, postoperative wound epithelialization was not observed in any patient; on the 30th day, wound healing occurred in 11/60 (18.3%) patients in the FE+BTA+PRP group and in none in the FE+BTA group (p=0.0003); on the 45th day — in 18/60 (30.0%) versus 3/65 (4.6%) patients (p=0.0001), respectively. The rates of wound healing depending on the type of tubes used on the 60th day postoperativ were comparable: in subgroup A (using two-component tubes), healing was observed in 21/29 (72.4%) cases, and in subgroup B (using single-component tubes) - in 16/22 (72.7%) cases; on the 30th day, epithelialization occurred in 11/29 (37.9%) cases in subgroup A and in none in subgroup B (0/22; 0%) (p=0.01). By 45th day the rate of postoperative wound healing increased in both subgroups: up to 51.7% (15/29 cases) with usage of two-component tubes and to 13.6% (3/22 cases) - with single-component tubes (p=0.007). A significant reduction in analgesic requirements and improvement in quality of life were noted in the study group. After centrifugation, the platelet level in two-component tubes was 397 × 10³/μL (346; 481), which was statistically significantly higher compared to single-component tubes at 239 × 10³/μL (106; 374) (p=0.001). The factor that statistically significantly increased the odds of epithelialization in univariate logistic regression analysis was the platelet level on the 30th day (OR=1.01; 95% CI: 1.00–1.02; p=0.008) and on the 45th day (OR=1.01; 95% CI: 1.00–1.01; p=0.007). The ROC analysis confirmed that a platelet concentration ≥452×10⁹/L in PRP is a statistically significant predictor of postoperative wound epithelialization time (p=0.001). CONCLUSION: intraoperative administration of low-leukocyte PRP in the surgical treatment of chronic anal fissure significantly accelerates postoperative wound epithelialization, reduces pain syndrome, and improves patients' quality of life. To optimize healing time, it is preferabli to achieve a platelet concentration in PRP of at least 452 × 10⁹/L.

AIM: to compare laser coagulation of the pilonidal sinus and its excision. P ATIENT S AND METHODS: a retrospective study included 113 patients with chronic inflammation of the pilonidal sinus without abscess, with a track no more than 9 cm. The main group underwent laser coagulation of the ECC, and the controls underwent its excision. The pain level, the healing time of postoperative wounds, and the postoperative relapses rate were assessed from days 2 to 6. The primary point of the study was the rate of wounds epithelialization on day 90. RESULT S: on day 90, wound healing occurred in 60/60 (100.0%) patients of the main group and 39/42 (92.9%) patients of the control group, p = 0.067. In the remaining 3/42 (7.1%) patients of the control group, wounds healed on day 95 in 2/42 (4.8%) cases and on day 240 in 1/42 (2.4%). The median duration of healing of postoperative wounds was 45 (35; 60) days in the main group and 85 (65; 90) days in the control group, p < 0.001. Recurrence of the disease occurred in 3/60 (5.1%) cases in the main group and in 2/42 (4.8%) cases in the control group, p = 0.104. CONCLUSION: laser coagulation is a highly effective and safe method of treating uncomplicated forms of pilonidal disease. The protocol of laser exposure and postoperative management has demonstrated its convenience and a good early result. It can be used as a variant of laser coagulation of the epithelial coccygeal passage.

B ACKGROUND: the optimal treatment strategy for patients with rectal cancer who achieve a complete or nearcomplete clinical response after neoadjuvant chemoradiotherapy is challenging. AIM: to assess oncological outcomes after neoadjuvant chemoradiotherapy followed by total mesorectumectomy (TME) or local excision of residual rectal tumor (TEM). MA TERIALS AND METHODS: a systematic review and meta-analysis were done according to the PRISMA 2020 guidelines. A literature search included PubMed, MEDLINE, and e-library databases until April 2025. Inclusion criteria were studies comparing long-term outcomes in patients treated with neoadjuvant chemoradiotherapy followed by surgical treatment consisting of total mesorectumectomy or local excision of residual rectal tumor. Exclusion criteria were lack of information on the study endpoints, unbalanced group sizes, preliminary results and a high risk of bias in quality of full-text articles. The primary endpoints of the study were 5-year disease-free survival (DFS) and overall survival (OS). Secondary endpoints included 1and 3-year DFS, 3-year OS, local recurrence rate and distant metastases. Generalized Kaplan-Meier curves were constructed for the meta-analysis of DFS and OS. RESULT S: the study included 10 comparative studies (3 randomized, 1 prospective, and 6 retrospective). The incidence of local recurrence was significantly higher in the TEM group than in TME — 36/496 (7.3%) versus 22/577 (3.8%) (OR = 1.85; 95% CI: 1.05–3.25; p = 0.032). The groups were comparable in distant metastases rate — 35/420 (8.3%) cases in the TEM group and 52/498 (10.4%) in TME (OR = 0.79; 95% CI: 0.49–1.27; p = 0.326). The median follow-up was 52.5 (95% CI: 49.4–52.5) months for the TEM group and 55.2 (95% CI: 55.2–59.7) months for TME. No significant differences in DFS were found between groups (p, log-rank test = 0.39). Five-year DFS was 79.2% (95% CI: 74.8–83.9) for TEM and 80.9% (95% CI: 76.9–85.1) for TME. When analyzing the hazard ratio, no advantage of TME over TEM was proven in DFS (HR = 1.31; 95% CI: 0.93–1.85; p = 0.117). In terms of overall survival, both treatment methods were comparable (p, log-rank test = 0.43), and the 5-year OS was 88.9% (95% CI: 85.4–92.6) for TEM and 87.6% (95% CI: 84.1–91.2) for TME. Hazard ratio analysis revealed no statistically significant differences (HR = 1.11; 95% CI: 0.70–1.71; p = 0.656). CONCLUSION: TEM is comparable to TME in oncological outcomes of patients with complete or near-complete clinical response after neoadjuvant chemoradiotherapy. However, selection criteria for this group of patients should be taken into account, such as the presence of a near-complete clinical response, small residual tumor size, affected mesorectal lymph nodes, and a tumor regression grade mrTRG 0-1.

AIM: to evaluate the risk of recurrent intussusception after removal of hamartomas in patients with Peutz-Jeghers syndrome (PJS) and to analyze the safety of endoscopic removal of small bowel hamartomatous polyps in this patient population. P ATIENT S AND METHODS: single-center retrospective study evaluated the endoscopic management of confirmed PJS followed from January 2022 to December 2025 in 39 patients. There were 103 elective procedures: 1) balloonassisted enteroscopy (BAE) with polypectomy (n = 92), and 2) intraoperative enteroscopy (IOE) (n = 11). The primary endpoint was the recurrent intussusception confirmed by imaging. Time-to-event analysis was performed using the Nelson-Aalen method. RESULT S: a total of 686 small bowel hamartomatous polyps were removed. The median number of polyps removed per procedure was 5 (IQR 3–8) for BAE and 10 (IQR 8–17) for IOE. Median operation time was 90 (58–115) minutes for BAE and 300 (200–360) minutes for IOE. Complications occurred in 11/103 (10.7%) cases: 7/92 (7.6%) with BAE and 4/11 (36.3%) with IOE. Most complications were managed endoscopically — 5/7 (71.5%) in the BAE group and 1/4 (25.0%) in the IOE group. An active endoscopic strategy using BAE enabled organ-sparing treatment of intussusception in 13 out of 15 (86.7%) cases. The cumulative probability of recurrent intussusception within the first year of follow-up was 20.4% (95% CI 0,0–43.9), and the median time to event was 23.9 months. CONCLUSIONS: balloon-assisted enteroscopy as a minimally invasive approach demonstrates high efficacy in resolving intussusception. Despite treatment, a significant risk of recurrent intussusception persists, necessitating longterm follow-up. BAE shows an acceptable safety profile, whereas IOE is associated with a higher complication rate, reflecting its use in complex cases.

OBJECTIVE: to evaluate the efficacy of PRP therapy following excision of chronic anal fissure (CAF) combined with pharmacological relaxation of the internal anal sphincter using 40 units of botulinum toxin type A (BTA). PATIENTS AND METHODS: single-center prospective randomized controlled trial (NCT07268261) was held between September 2023 and November 2025comparing outcomes of fissure excision (FE) combined with 40 units of BTA plus platelet-rich plasma injection (FE + BTA + PRP — study group) versus FE with BTA alone (FE + BTA — control group).142 patients were randomized during this period: 70 in FE + BTA + PRP group and 72 in FE + BTA group. 125 patients were included in the final analysis after applying exclusion criteria: 60 in the study group and 65 in the control group. During preoperative and postoperative period patients underwent control examinations, pain intensity assessment using the visual analog scale (VAS), profilometry, and evaluation of transient fecal incontinence using the Wexner scale. The primary end point was the rate of wound epithelialization at 60 days post-surgery. RESULTS: on the 60 ^th days, wound healing rates were comparable between both groups: 43/60 (71.7%; 95% confidence interval [CI]: 58.6–82.5) in the FE + BTA + PRP group versus 47/65 (72.3%; 95% CI: 59.8–82.7) in the FE + BTA group (p = 0.936). However, on the 15th days, no patients had epithelialized wounds; on the 30th days, wound healing occurred in 11/60 (18.3%) patients in the FE + BTA + PRP group versus none in the FE + BTA group (p = 0.0003); on the 45th days — in 18/60 (30.0%) versus 3/65 (4.6%) patients respectively (p = 0.0001). No postoperative complications developed in any patient. Transient fecal incontinence on the 30th days was observed in 12/60 (20.0%) patients in the studied group and 10/65 (15.4%) in the control group (p = 0.498); on the 60th days — in 5/60 (8.3%) and 2/64 (3.1%) patients, respectively (p = 0.262). Pain intensity during the day and during defecation in the postoperative period was comparable between two groups throughout the observation period, except of day 10 (during defecation, p = 0.049) and day 12 (during the day, p = 0.036; during defecation, p = 0.035), with lower scores in the control group; by day 60, pain was successfully relieved in almost all patients in both groups. According to profilometry data on the 30th days internal anal sphincter (IAS) spasm persisted in 15/48 (31.3%) patients in the study group and 10/51 (19.6%) in the control group (p = 0.183); on the 60th days — in 15/45 (33.3%) and 11/49 (22.4%) patients, respectively (p = 0.239). No statistically significant differences were achieved in favor of the study group regarding the number of days of temporary disability — 15 (11; 22) days in the FE + BTA + PRP group versus 20 (13; 27) in the FE + BTA group (p = 0.079). Female gender was identified as a factor significantly increasing the odds of absence of epithelialization on the 30th days in univariate logistic regression analysis (odds ratio [OR] = 3.95; 95% CI: 1.09–14.37; p = 0.037). On the 45th days, in addition to gender (OR = 3.29; 95% CI: 1.26–8.61; p = 0.015), significant factors were: treatment method in favor of the FE + BTA + PRP group (OR = 0.11; 95% CI: 0.03–0.41; p = 0.0009); age (OR = 1.07; 95% CI: 1.01–1.13; p = 0.015); and presence of constipation (OR = 5.14; 95% CI: 1.43–18.53; p = 0.013). On the 60th days, only female gender was statistically significantly associated with non-healing wound (OR = 3.22; 95% CI: 1.22–6.66; p = 0.019). No factors influencing the presence of transient fecal incontinence were identified. CONCLUSION: the use of platelet-rich plasma combined with BTA injection and FE in the treatment of CAF does not increase the rate of postoperative wound epithelialization at 2 months after surgery; however, it offers an advantage by increasing the rate of epithelialization at 30 and 45 days. At the same time this method does not affect the incidence of postoperative complications, pain intensity, functional treatment outcomes, or social and occupational rehabilitation of patients.

Relevance. Rectovaginal fistulas are still one of the unresolved problems in coloproctology, and the recurrence rate after surgical treatment reaches 40–80 %. Given this, the search for a surgical method that will improve the results of treatment continues. Objective: To evaluate the immediate and long-term results of surgical treatment of rectovaginal fistulas using dislocated lateral flaps of the vagina and rectum (DLF). Materials and methods: A single-center prospective non-randomized study included 50 patients with rectovaginal fistulas of various etiologies who underwent DLF surgery between September 2023 and December 2025. The primary endpoint was the recurrence rate, and the secondary endpoints were the complication rate, the duration of surgery, the duration of hospitalization, the intensity of pain (according to the visual analog scale), the functional state of the anal sphincter (sphincterometry, Wexner scale), the quality of life (SF-36 questionnaire), and the factors that may affect the recurrence rate after DLF. Results: The frequency of RBC relapses was 14/50 (28 %; 95 % confidence interval: 16–43) cases, while in 5/14 cases marked positive dynamics with the reduction of clinical manifestations was noted. Postoperative complications developed in 3/50 (6 %) patients (2 hematomas, 1 bleeding). The duration of surgical intervention was 40 (30; 45) minutes. The length of hospital stay ranged from 6 to 28 days with a median of 8 (7; 11) days. When assessing the pain syndrome according to VAS, all patients experienced mild pain during the week of hospital stay (1–3 points). By the seventh day, the majority (39/45 (87 %)) of the patients who remained under hospital supervision continued to experience mild pain of 1 point, the rest (6/45 (13 %)) of 2 points. According to sphincterometry data, the average pressure in the anal canal at rest increased statistically significantly after applying the DLF method (38 (35; 40) mmHg before application, and 40 (38; 45) mmHg after application, respectively (p=0.0007)), when studying the maximum pressure in There were no statistically significant changes in the anal canal during voluntary contraction (157 (122; 192) mmHg and 148 (122; 196) mmHg, respectively (p=0.168)). There was an improvement in quality of life scores on most SF-36 scales (p<0.05), except for role functioning due to physical condition (p=0.996). The only risk factor associated with the recurrence of rectovaginal fistulas was the location of the fistula opening in the lower third of the vagina (odds ratio = 5.21; 95 % confidence interval: 1.01–26.8; p=0.048). Conclusion: The method of dislocated lateral flaps of the vagina and rectum demonstrates high efficiency in the treatment of rectovaginal fistulas, is accompanied by a low complication rate, does not worsen functional results and improves the quality of life.

AIM: evaluating effectiveness and safety of the method of fistula repair using a lateral rectal flap in patients with anal fistulas involving more than 1/3 of the external sphincter (complex anal fistulas). PATIENTS AND METHODS : a single-centre, prospective, single-group study included 60 patients who underwent anal fistula repair using a lateral rectal flap (LRF). The check-up before and after the surgery was carried out using instrumental methods — transrectal ultrasound (TRUS) and sphincterometry. The majority of patients had an extrasphincteric fistula (41/60 (68.3%)), pararectal cavities were detected in 39/60 (65%) patients, including multiple cavities in 23/39 (38.3%). The late results were studied after 3–12 months. The median follow-up was 7 (4; 8) months. The primary endpoint was the rate of non-recurrence cases (treatment effectiveness), the secondary ones were the assessment of continence, pain syndrome, risk factors for unsatisfactory results (recurrence). RESULTS: the effectiveness of the LRF method was 48/60 (80%; 95% CI 67.7; 89.2) cases. Sphincterometry and Wexner’s incontinence scale showed no worsening of continence after surgical treatment (1 (0; 3) point before the surgery and 2 (0; 3) points after 3–6 months (p = 0.68)). The assessment of risk factors for unsatisfactory results of LRF application revealed such factors as excess body weight (body mass index ≥ 30.7 kg/m²) (body mass index ≥ 30.7 kg/m²) (odds ratio (OR) = 1.14 (95% coincidence interval (CI) 1.02; 1.29), p = 0.02); purulent intersphincteric leaks (OR = 5.50 (95% CI 1.14; 26.6), р = 0.03); purulent ischioanal leaks(OR = 16.8 (95% CI 3.20; 7.55), р = 0.0009) and purulent pelviorectal leaks(OR = 7.86 (95% CI 1.69; 36.6), р = 0.008), as well as multiple purulent cavities (OR = 4.40 (95% CI 1.14; 16.9), р = 0.03).At the same time, the LRF method allows to achieve recovery in 28/39 (71.8%) patients with solitary cavities, and in 15/23 (65.2%) cases of multiple cavities. CONCLUSION : the LRF method allows for the one-stage elimination of “complex” anal fistulas in 80% of cases, without worsening of anal continence. According to the Visual Analogue Scale, the median score did not exceed 3 for the entire follow-up period, what corresponds to a low level of pain; at the same time, the maximum intensity was noted on the 2–4 days after surgery, whereas by the 10 day almost all patients did not experience pain.

AIM : to assess late functional outcomes and quality of life of restorative proctocolectomy with J-pouch in patients with ulcerative colitis. PATIENTS AND METHODS: the retrospective study included 76 patients operated in 2013–2018. Quality of life and continence were assessed using the SF-36 questionnaire and the Wexner incontinence scale. The first survey was done in 2018–2019, and the second one — in 2025. Complete paired data were obtained from 49 (64.5%) patients. Paired comparisons between the two surveys were performed using the Wilcoxon signed-rank test. Associations between QoL and continence function were analyzed using multiple linear regression. RESULTS: a significant decrease was detected in several SF-36 domains: general health (GH) 67 (50; 82) vs 57 (47; 75), p = 0.028; vitality (VT) 67 (50; 82) vs 57 (47; 75), p = 0.0008; mental health (MH) 72 (60; 86) vs 64 (52; 74), p = 0.013; and in the mental component summary (MCS) 51.1 (40.5; 55.1) vs 45.3 (38.7; 51), p = 0.013. No significant differences were found in the remaining domains. A marked increase in incontinence symptoms was noted over time: the median Wexner score increased from 1 (0; 2) to 4 (1; 10.5), p < 0.0001. However, no significant association was found between deterioration of continence and quality of life according to regression analysis. Female gender was identified as an independent predictor of lower QoL (p = 0,046). CONCLUSION: over time, patients with a J-pouch demonstrated a significant decline in continence function and quality of life due to worse psychoemotional domains, while physical components remained relatively stable. No significant correlation was found between QoL and continence impairment.

AIM: to compare the clinical features and quality of life estimation in patients with chronic constipation due to idiopathic megacolon/megarectum and slow-transit constipation. PATIENTS AND METHODS: the comparative retrospective analysis (2003-2024) had been provided in 260 patients with chronic constipation, which were undergone barium enema to exclude/confirm megacolon/megarectum. 1 group (n=158) consisted of patients with idiopathic megacolon/megarectum. Hirschsprung’s disease was excluded in all patients based on complex of clinical features, barium enema and anorectal manometry results and (if needed) rectal Swenson’s biopsy. 102 patients with chronic slow-transit constipation and normal size of the bowel were included in 2 group. RESULTS: In 1 group patients were statistically significant younger (Me=26.0 (19.0; 43.0) years and Me=33.0 (23.0; 48.0) years (p=0.043)) and significant male predominance were observed (87/158 (55.1%) vs 15/102 (14.7%), (p CONCLUSION: patients with chronic constipation due to idiopathic megacolon/megarectum have significant better quality of life and lower burden of clinical features then slow-transit constipation ones.

AIM: to assess efficacy of botulinum toxin type A (BTA) at a dosage of 80 units for chronic anal fissure (CAF) without excision.PATIENTS AND METHODS: single-center prospective randomized controlled trial (NCT05598164) was held between September 2022 and December 2024 in order to compare isolated usage of BTA (main group) at a dosage of 80 units with its combination with excision of the fissure — BTA + EF (control group) for CAF. One hundred sixty-seven were randomized — 86 were included in main group and 81 — in control one. After application of exclusion criteria 126 patients were included in final analysis: 65 in group of BTA only and 61 in group of its combination with EF. Control examination, pain syndrome intensity according to visual-analogue scale (VAS), profilometry and assessment of transitory anal incontinence according to Wexner scale were done in pre- and postoperative period. The primary endpoint was epithelization of defect (for the main group) or postoperative wound (for the control group) on 60th day after surgery.RESULTS: on the 60th day postoperative defect healed in 46/59 (78.0%; 95% confidence interval (CI): 65.2–87.7) patients in main group vs. 34/50 (68.0%; 95% CI: 53.3 — 80.5) patients for postoperative wound in control group (р = 0.3). At the same time, on the 15th day defect healed in 12/65 (18.4%) patients in BTA group, whereas no one's postoperative wound healed in group BTA + EF (р = 0.0003); on the 30th day — in 18/59 (30.5%) vs. 1/53 (1.9%) patients(р < 0,0001); on the 45th day — in 31/57 (54.4%) vs. 3/52 (5.8%) patients(р < 0.0001). The rate of postoperative complications was 23/65 (35.4%) in main group and 23/61 (37.7%) in controls (р = 0.8). On the 30th day transitory anal incontinence was detected in 15/60 (25.0%) patients in BTA group and in 18/53 (34.0%) in combinations of its injection with EF (p = 0.3); on the 60th day — in 7/60 (11.7%) and 9/51 (17.6%) patients (p = 0.4); external hemorrhoids thrombosis developed in 2/65 (3.1%) patients of main group and in 2/61 (3.3%) of control group (p = 1.0); intrasphincter fistula — in 5/60 (8.3%) and 3/50 (6.0%) patients (p = 0.7). Intensity of pain syndrome during the day and while defecation began to decrease in patients of main group from the 1st day after surgery, whereas it increased and returned to pre-operative level in control group by the 3d day, where remained till the 9th day, only after this it decreased. Significant differences between groups were revealed to 48–49th days. According to profilometry, spasm of internal anal sphincter (IAS) remained in 22/56 patients of main group and in 16/52 patients of control group; on 60th day — in 22/52 (39.3%) and 8/50 (16.0%) patients relatively (p = 0.004). In group of BTA there were statistically significantly fewer days of disability than in group of combination BTA with EF — 7 (6; 15) vs. 20 (15; 30) days. Method of treatment BTA + EF became significant factor, increasing chances of no epithelization on the 30th (odds ratio (OR) = 22.8; 95% CI: 2.93–178.0; р = 0.003) and 45th (OR = 19.5; 95% CI: 5.43–69.8; р < 0.0001) days. On the 60th day presence of IAS spasm was statistically significantly associated with non-healing (OR = 2.68; 95% CI: 1.08–6.66; р = 0.034). The factors which could influence the existence of transitory anal incontinence, were not detected.CONCLUSION: refusal from EF while BTA's use at a dosage of 80 units allows to achieve defect epithelization on early post-operative period, lower intensity of pain syndrome and significantly decrease time of temporary disability.