BACKGROUND: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patient lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended. METHODS: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated. RESULTS: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and in the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory. CONCLUSION: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and for researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

Background: Foreign bodies in the rectum are among the rarest conditions encountered in emergency surgery and can have various etiologies.Aim: To examine the patterns of injury, diagnostic methods, surgical options, and outcomes associated with foreign bodies of the rectum.Materials and methods. A retrospective analysis was conducted on the treatment outcomes of 47 patients with rectal foreign bodies who received care at various surgical hospitals in the Khanty-Mansiysk Autonomous Okrug — Ugra from 2019 to 2023. The study examined factors such as sex and age distribution, etiology, duration of the treatment period, diagnostic features, and types of medical interventions. The results of treatment and length of hospital stay were also assessed. A criminal history was noted in only one patient (2.1 %). The insertion of a foreign body into the rectum for sexual pleasure was reported by 42 patients (89.4 %). Non-sexual causes were responsible for the condition in 4 patients (8.5 %).Results. In the analysed group there were 29 (61.7 %) young people, 9 (19.1 %) middle-aged people, 8 (17.0 %) elderly people, and one (2.2 %) in the senior age group. The average age of the patients was 42 ± 13 years. There were 33 men (70.2 %) and 14 women (29.8 %). In the first 3 hours, 10 (21.3 %) people sought medical treatment, after 1—3 days — 34 (72.3 %) patients, and after 4 days — 3 (6.4 %) patients. In most cases, in 42 (89.3 %) patients, the foreign body was removed transanally. If transanal removal was impossible, laparotomy was performed in 5 (10.6 %) patients.Conclusion. Sexual gratification was the most common reason for the insertion of a foreign body into the rectum. To prevent perforation and improve the prognosis of this pathological condition, timely diagnosis and treatment are necessary

Аim: Evaluation of methods for pain prevention and pain reduction after anorectal surgery at all stages of treatment based on publications found in available databases.Key points. Most anorectal diseases are benign and do not affect life expectancy, meanwhile about 40 % of the population suffer from it. Mainly anorectal disorders affect middle-aged people reducing their life quality. At the same time many articles aimed at studying only postoperative anesthesia. 2 researchers independently searched for articles published in Medline, Scopus, Cochrane, Web of Science, E-library databases using keywords. A total of 54 publications were included. A multimodal approach should include the pain prevention during pre-, intra- and postoperative periods. Acetaminophen is recommended for pain reduction according to the dosing protocols. Acetaminophen combined with other systemic analgesics is advisable for patients with severe pain. The opioids use is justified only for moderate-severe postoperative pain. Metronidazole and lidocaine with nitroglycerin ointment/ nifedipine/сorticosteroids effectiveness has been proven for local postoperative anesthesia. Prophylactic use of antibiotics and bowel preparation do not reduce postoperative pain. Stool softeners are recommended for reducing postoperative pain severity. Additional local anesthesia such as nerve blockade or infiltration anesthesia is recommended for all patients. Modern minimally invasive treatment methods of hemorrhoid are associated with less severe postoperative pain.Conclusion. The recommended scheme of multimodal anesthesia for patients after anorectal surgery is shown on Fig.1. Further studies are needed to evaluate preoperative anesthesia effectiveness, the feasibility of the perioperative flavonoids use, as well as comparisons of various minimally invasive treatment methods of anorectal diseases.

Aim: To evaluate the medical care quality provided to patients with fecal incontinence in practice; to investigate the patient care effectiveness; to identify the problems the patient and the doctor are faced during the postpartum anal incontinence (AI) treatment.Methods: A questionnaire for surgeons was created using Google forms. It includes 22 questions about medical characteristics of patients with AI, used diagnostic methods, and treatment results. The answers were analyzed and presented as histograms.Results: Totally 134 (17.4%) questionnaires were completed from September to November 2020. Labor was the most common AI cause (74.4%). The median age was 20-40 years, 37% of patients was >40 years, 8% – >60 years. The most common complaints were incontinence (70%) and decreased life quality (72%). Rectovaginal fistulas were diagnosed in 28% of cases. The sphincter complex lesion size, age and anorectal manometry results determined the treatment strategy. Only 8.8% of surgeons suggested sacral neurostimulation in case of the other methods inefficiency. Up to 16.7% of patients were offered to create stoma as the final treatment method.Discussion: Our study is the first major survey for proctologists and surgeons in Russia, assessing the medical care of patients with postpartum AI. The results indicate insufficient attention to this problem; it requires educational and organizational solutions. Regional or federal centers where obstetrician and surgeons can work cooperatively could be extremely helpful to provide appropriate medical care to these patients and to improve the treatment quality for women with postpartum AI.

Aim: to compare short- and long-term results of primary midline closure and gluteus maximus fascia flap plasty after pilonidal sinus excision. Method: retrospective analysis included consecutive patients who had primary and recurrent pilonidal sinus excised. Patients with gluteus maximus fascia flap plasty formed 1st group, patients with primary midline closure formed 2nd group. Gluteus maximus fascia flap plasty technique: (i) separation in lateral directions of both gluteus maximus fascia from muscle and subcutaneous tissue; (ii) mobilised fascia flaps are brought together to midline and sutured; (iii) subcutaneous fat and skin sutured. Results: 60 patients operated in 2007-2016 were included: 28 in 1st group, 32 in 2nd group. Groups 1 and 2 didn’t differ in operation time (41.9±4.0 and 37.3±3.1 min, p=0.4), blood loss (6.9±0.5 and 8.3±1.6 ml, p=0.2), draining rate (7.1% and 12.5%, p=0.5), hospital stay (11.8±1.3 and 9.1±1.0 days, p=0.1), time to complete wound epithelialization (1.2±0.2 and 1.5±0.4 months, p=0.37). Mean follow-up was 20.7±3.2 and 53.8±6.5 months respectively. Recurrence rate was significantly lower in gluteus maximus fascia flap plasty group (3.6%) than in the 2nd group (21.9%, p=0.04). Conclusion: gluteus maximus fascia flap plasty after pilonidal sinus excision is feasible, doesn’t increase postoperative complications rate and leads to a lower recurrence rate compared to midline closure.

Background: According to current literature, anastomosis leakage holds a leading position among all complications of colorectal surgery. A particular area of prevention of this complication in colorectal oncology is the research of the possibilities of using biological adhesive compounds as a universal biological and mechanical barrier to the spread of intraluminal microflora and tumor cells.Clinical case: A 65-year-old patient (female) was hospitalized with a diagnosis of rectal cancer cT3cN1cM0 (stage III) after neoadjuvant chemoradiotherapy. Surgical treatment was performed: the laparoscopic low anterior resection of the rectum with expanded lymphodissection, protective loop ileostomy. The anastomosis was formed at a height of 4 cm from the anus. Intraoperatively, the anastomosis line was strengthened using the Vivostat R system product. The technology of on-site preparation and application of the compound is described in the paper.. The postoperative period passed without complications.Conclusion: Due to the possible economic, oncological and postoperative advantages, the use of modern fibrin adhesive compositions is quite promising for introduction into surgical practice. It is required to conduct research aimed at studying the effectiveness of this method of preventing the leakage of colorectal anastomoses.