Year 2023 Vol. 31 No 5

SCIENTIFIC PUBLICATIONS

E.A. TONEEV, R.F. SHAGDALEEV, O.V. PIKIN, A.A. MARTYNOV, O.V. MIDLENKO, G.R. CHUKANOVA

FREQUENCY AND INDICATORS OF PROLONGED PLEURISY DEVELOPMENT AFTER LOBECTOMY FOR LUNG CANCER

Ulyanovsk Regional Clinical Oncologic Dispensary,
Ulyanovsk State University, Ulyanovsk,
Moscow Research Institute of Oncology named after P.A. Herzen - branch. P.A. Herzen Oncology Research Institute - branch of FGBU "National Medical Research Center of Radiology",
Ministry of Health of Russia, Moscow,
Russian Federation

Objective. To identify prognostic factors associated with prolonged postoperative pleural effusion after lobectomy for lung cancer.
Methods. The study was conducted on the base of the surgical department of thoracic oncology of the State Budgetary Healthcare Institution «Oncology Clinical Dispensary» in Ulyanovsk. The analysis included patients who underwent lobectomy with ipsilateral mediastinal lymph node dissection from March 01, 2023, to November 10, 2023. A total of 111 surgical interventions were performed; 66 patients were excluded from the study. 45 patients were included in the study, 23 of whom had no prolonged pleural effusion, and 22 patients experienced prolonged postoperative pleural effusion. Characteristics of the study participants were assessed using a standardized protocol.
Results. The frequency of prolonged pleural effusion development was 22/45 (48.9%). In conducting a multifactorial analysis of the probability of prolonged pleural effusion development, two statistically significant indicators were identified: «neutrophil-leukocyte index on the 5th day» and «protein in drainage fluid on 2nd day.» Threshold values for these parameters were determined: for the protein in drainage fluid on the 2nd day – 32.1 g/L, for the neutrophil-leukocyte index on the 5th day – 2.889. Beyond these threshold values, the risk of developing prolonged pleuritis statistically increased (p<0.001).
Conclusion. The frequency of prolonged pleuritis development was 22/45 (48.9%). Multifactorial analysis revealed statistically significant criteria: the neutrophil-leukocyte index on the 5th day and the protein quantity in pleural fluid on the 2nd day. When these values exceed the threshold, the risk of prolonged pleuritis development in patients increases (p<0.001).

Keywords: prolonged pleurisy, lung cancer, lobectomy, lung resection
p. 351-361 of the original issue
References
  1. Utter GH. The rate of pleural fluid drainage as a criterion for the timing of chest tube removal: theoretical and practical considerations. Ann Thorac Surg. 2013 Dec;96(6):2262-67. doi: 10.1016/j.athoracsur.2013.07.055
  2. Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg. 2014 Feb;45(2):241-46. doi: 10.1093/ejcts/ezt376
  3. Zhang TX, Zhang Y, Liu ZD, Zhou SJ, Xu SF. The volume threshold of 300 versus 100 ml/day for chest tube removal after pulmonary lobectomy: a meta-analysis. Interact Cardiovasc Thorac Surg. 2018 Nov 1;27(5):695-702. doi: 10.1093/icvts/ivy150
  4. Olgac G, Cosgun T, Vayvada M, Ozdemir A, Kutlu CA. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy. Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):650-55. doi: 10.1093/icvts/ivu207
  5. Paone G, de Rose G, Giudice GC, Cappelli S. Physiology of pleural space after pulmonary resection. J Xiangya Med. 2018;3(3). doi: 10.21037/JXYM.2018.03.01
  6. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, Nicholson AG, Groome P, Mitchell A, Bolejack V; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016 Jan;11(1):39-51. doi: 10.1016/j.jtho.2015.09.009
  7. Brunelli A, Beretta E, Cassivi SD, Cerfolio RJ, Detterbeck F, Kiefer T, Miserocchi G, Shrager J, Singhal S, Van Raemdonck D, Varela G. Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg. 2011 Aug;40(2):291-97. doi: 10.1016/j.ejcts.2011.05.020
  8. Hristova R, Pompili C, Begum S, Salati M, Kefaloyannis M, Tentzeris V, Papagiannopoulos K, Brunelli A. An aggregate score to predict the risk of large pleural effusion after pulmonary lobectomy. Eur J Cardiothorac Surg. 2015 Jul;48(1):72-76. doi: 10.1093/ejcts/ezu413
  9. Kosugi S, Kanda T, Yajima K, Ishikawa T, Sakamoto K. Risk factors influencing the pleural drainage volume after transthoracic oesophagectomy. Eur J Cardiothorac Surg. 2013 Jun;43(6):1116-20. doi: 10.1093/ejcts/ezs556
  10. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017 Jan 3;10(1):12. doi: 10.1186/s13104-016-2335-5
  11. Azab B, Camacho-Rivera M, Taioli E. Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PLoS One. 2014 Nov 6;9(11):e112361. doi: 10.1371/journal.pone.0112361. eCollection 2014.
  12. Yakuwa K, Miyaji K, Kitamura T, Miyamoto T, Ono M, Kaneko Y. Neutrophil-to-lymphocyte ratio is prognostic factor of prolonged pleural effusion after pediatric cardiac surgery. JRSM Cardiovasc Dis. 2021 Apr 19;10:20480040211009438. doi: 10.1177/20480040211009438
  13. Chen C, Wang Z, Hao J, Hao X, Zhou J, Chen N, Liu L, Pu Q. Chylothorax after Lung Cancer Surgery: A Key Factor Influencing Prognosis and Quality of Life. Ann Thorac Cardiovasc Surg. 2020 Dec 20;26(6):303-10. doi: 10.5761/atcs.ra.20-00039
  14. Toneev EA, Pikin OV, Charyshkin AL. Lymphotropic therapy in the prevention of postoperative complications in patients with lung cancer. P.A. Herzen Journal of Oncology. 2023;12(2):19 25. (In Russ.) doi: 10.17116/onkolog20231202119 (In Russ.)
  15. Li C, Kazzaz FI, Scoon JM, Estrada-Y-Martin RM, Cherian SV. Lymphocyte predominant exudative pleural effusions: A narrative review. Shanghai Chest. 2022;6. doi: 10.21037/SHC-21-11/COIF
  16. Tang MB, Li JL, Tian SY, Gao XL, Liu W. Predictive factors for pleural drainage volume after uniportal video-assisted thoracic surgery lobectomy for non-small cell lung cancer: a single-institution retrospective study. World J Surg Oncol. 2020 Jul 8;18(1):162. doi: 10.1186/s12957-020-01941-5
  17. Yang Z, Hu T, Shen H, Huang H. Application of small-bore pigtail catheter to improve pleural drainage after single-incision thoracoscopic lobectomy for lung cancer. ANZ J Surg. 2020 Jan;90(1-2):139-143. doi: 10.1111/ans.15595
  18. Lai Y, Wang X, Zhou H, Kunzhou PL, Che G. Is it safe and practical to use a Foley catheter as a chest tube for lung cancer patients after lobectomy? A prospective cohort study with 441 cases. Int J Surg. 2018 Aug;56:215-20. doi: 10.1016/j.ijsu.2018.06.028
  19. Li X, Chen X, He S, Chen H. The Application of Pigtail Catheters in Postoperative Drainage of Lung Cancer. Clin Lung Cancer. 2022 May;23(3):e196-e202. doi: 10.1016/j.cllc.2021.07.010
  20. Song Y, Zheng C, Zhou S, Cui H, Wang J, Wang J, Wang W, Liu L, Liu J. The application analysis of 8F ultrafine chest drainage tube for thoracoscopic lobectomy of lung cancer. J Cardiothorac Surg. 2021 Apr 21;16(1):104. doi: 10.1186/s13019-021-01479-x
  21. Yan S, Wang X, Lv C, Phan K, Wang Y, Wang J, Yang Y, Wu N. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage. J Thorac Dis. 2016 Mar;8(3):415-21. doi: 10.21037/jtd.2016.02.13
  22. Filosso PL, Ruffini E, Sandri A, Lausi PO, Giobbe R, Oliaro A. Efficacy and safety of human fibrinogen-thrombin patch (TachoSil®) in the treatment of postoperative air leakage in patients submitted to redo surgery for lung malignancies: a randomized trial. Interact Cardiovasc Thorac Surg. 2013 May;16(5):661-66. doi: 10.1093/icvts/ivs571
Address for correspondence:
432017, Russian Federation,
Ulyanovsk, 12, September st. 90,
Regional State Health Institution
Clinical Oncology Dispensary,
tel. +79084731198,
e-mail: e.toneev@inbox.ru,
Toneev Evgeniy A.
Information about the authors:
Toneev Evgeniy A., PhD, Thoracic Surgeon of the Surgical Department of Thoracic Oncology of the State Healthcare Institution Regional Clinical Oncology Dispensary of Ulyanovsk, Associate Professor of the Department of Faculty Surgery, Faculty of Medicine named after T.Z. Biktimirova, Institute of Medicine, Ecology and Physical Culture, Ulyanovsk State University, Ulyanovsk, Russian Federation.
https://orcid.org/0000-0001-8590-2350
Shagdaleev Roman F., Resident of the Department of Hospital Surgery, Anesthesiology, Resuscitation, Urology, Traumatology And Orthopedics, Faculty of Dentistry, Pharmacy and Postgraduate Medical Education, Institute of Medicine, Ecology and Physical Culture, Federal State Budgetary Educational Institution of Higher Education Ulyanovsk State University, Ulyanovsk, Russian Federation
https://orcid.org/0009-0004-0218-666X
Pikin Oleg V., MD, Professor, Head of the Thoracic Surgical Department, Moscow Oncological Institute named after. P.A. Herzen – Branch of the Federal State Budgetary Institution «National Medical Research Center of Radiology» of the Ministry of Health of Russia, Moscow, Russian Federation
https://orcid.org/0000-0001-6871-6804
Martynov Alexander A., Thoracic Surgeon, Head of the Surgical Thoracic Department of the State Healthcare Institution, Ulyanovsk, Russian Federation
https://orcid.org/0000-0003-4662-9886
Midlenko Oleg V., MD, Professor of the Department of Hospital Surgery, Ulyanovsk State University. Ulyanovsk, Russian Federation.
https://orcid.org/0000-0001-8076-7145.
Chukanova Gulfiya R., Physician of Clinical Laboratory Diagnostics, Head of Laboratory, State Health Institution Regional, Clinical Oncology Dispensary , Russian Federation
https://orcid.org/0009-0005-7020-8522

M.YU. PIKUNOV 1, A.A. PECHETOV 1, O.O. GOLOUNINA 2, E.V. BONDARENKO 2, Z.E. BELAYA 2

SURGICAL TREATMENT OF PATIENTS WITH ACTH-PRODUCING NEUROENDOCRINE TUMOR OF BRONCHOPULMONARY LOCALIZATION: THE EXPERIENCE OF NATIONAL MEDICAL RESEARCH CENTER FOR SURGERY NAMED AFTER A.V. VISHNEVSKY

National Medical Research Center of Surgery named after A. V. Vishnevsky of the Ministry of Health of the Russian Federation 1,
National Medical Research Center for Endocrinology 2, Moscow,
Russian Federation

Objective. To create a methodological scheme for effective surgical treatment of patients with bronchopulmonary ACTH-producing neuroendocrine tumors (NET), varying severity of hypercortisolism, with minimal risk of early postoperative complications.
Methods. The study included patients who underwent examination and surgical treatment of ACTH-producing NET of bronchopulmonary localization in the period from 2004 to August 2023. Demographic information about patients, anamnesis data, results of hormonal and instrumental studies at pre- and postoperative stages, long-term treatment results have been analyzed. The control follow-up period after surgery ranged from 6 months to 5 years.
Results. The study included 74 patients. The age at the time of diagnosis of the disease ranged from 21 to 76 years, in an almost equal ratio of men and women. Due to the severity of the condition, 3 patients were denied surgical treatment. 71 patients underwent surgery. Atypical lung resection was performed (n=27 (38%)), segmentectomy (n=19 (26.8%)), lobectomy (n=25 (35.2%)) with a radicality index of R0. Typical carcinoid was verified in 48 patients (67.6%), atypical carcinoid – in 23 (23.4%). Single metastases in remote mediastinal lymph nodes were detected in 8 patients. A decrease in blood cortisol 60 minutes after the removal of the tumor was noted in 90% of patients. No postoperative complication was reported. Repeated surgical intervention for 6 patients was performed after 12-36 months of follow-up. 60 months of follow-up later it was possible to obtain data from 46 patients. The lethality was 5 patients.
Conclusion. In the surgical treatment of patients with ACTH-producing pulmonary NET it is necessary to be guided by the scale of condition severity assessment, the data of radiation diagnostics, preoperative possible verification to select an adequate volume of surgical intervention. The analysis of this experience of surgical treatment does not differ from the indicators in other world clinics. Its advantage include the absence of postoperative complications.

Keywords: ectopic ACTH-syndrome (EAS); neuroendocrine tumor (NET); hypercortisolism; bronchial carcinoid; surgical treatment; long-term results
p. 362-373 of the original issue
References
  1. Pikunov MYu, Dobreva EA, Kuznetsov NS, Latkina NV. ACTH-producing neuroendocrine lung tumors. Oncology. Journal named after PA. Herzen. 2014;3(2):54-58 (In Russ.).
  2. Lacroix A, Feelders RA, Stratakis CA, Nieman LK. Cushing’s syndrome. Lancet 2015; 386(9996): 913–927. doi: 10.1016/S0140-6736(14)61375-1.
  3. Feelders R, Sharma S, Nieman L. Cushing’s syndrome: epidemiology and developments in disease management. CLEP 2015: 281. doi: 10.2147/CLEP.S44336.
  4. Golounina OO, Belaia ZhE, Rozhinskaia LIa, Marova EI, Pikunov MIu, Khandaeva PM, Arapova SD, Dzeranova LK, Kuznetsov NS, Fadeev VV, Mel’nichenko GA, Dedov II. Clinical and laboratory characteristics and results of treatment of patients with ACTH-producing neuroendocrine tumors of various localization. Therapeutic Archive. 2021;93(10):1171–78. doi: 10.26442/00403660.2021.10.201102. (In Russ.)
  5. Golounina OO, Belaia ZhE, Rozhinskaia LIa, Pikunov MIu, Markovich AA, Dzeranova LK, Marova EI, Kuznetsov NS, Fadeev VV, Mel’nichenko GA, Dedov II. Survival predictors in patients with ectopic ACTH-syndrome. Problems of Endocrinology. 2022;68(6):30–42. doi: 10.14341/probl13144. (In Russ)
  6. Sathyakumar S, Paul TV, Asha HS, Gnanamuthu BR, Paul MJ, Abraham DT, Rajaratnam S, Thomas N. Ectopic Cushing Syndrome: A 10-Year Experience from a Tertiary Care Center in Southern India. Endocr Pract. 2017; 23(8): 907–14. doi: 10.4158/EP161677.OR.
  7. Pikunov MIu, Kuznetsov NS, Latkina NV, Dobreva EA, Remizov OV. AKTG-produtsiruiushchie opukholi bronkholegochnoi lokalizatsii. Khirurgiia. Zhurn im NI Pirogova. 2014;(5):21-27. (In Russ.)
  8. Pikunov MY, Pechetov AA, Golounina OO. Features of preparation and surgical aspects of treatment of patients with ACTH-producing neuroendocrine lung tumors. Endocrine Surgery. 2021;15(2):4-12. (In Russ.). doi: 10.14341/serg12721.
  9. Isidori AM, Kaltsas GA, Pozza C, Frajese V, Newell-Price J, Reznek RH, Jenkins PJ, Monson JP, Grossman AB, Besser GM. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J Clin Endocrinol Metab. 2006; 91(2): 371–377. doi: 10.1210/jc.2005-1542.
  10. Shah S, Gosain R, Groman A, Gosain R, Dasari A, Halfdanarson TR, Mukherjee S. Incidence and Survival Outcomes in Patients with Lung Neuroendocrine Neoplasms in the United States. Cancers. 2021; 13(8): 1753. doi: 10.3390/cancers13081753.
  11. Golounina OO, Slashchuk KYu, Khairieva AV, Tarbaeva NV, Degtyarev MV, Belaya ZhE. X-ray and radionuclide imaging in the diagnosis of ACTH-producing neuroendocrine tumors. Med Radiology and Radiation Safety 2022; 67(4): 80–88. (In Russ)]. doi: 10.33266/1024-6177-2022-67-4-80-88.
  12. Buryakina SA, Karmazanovsky GG, Volevodz NN, Pikunov MYu, Tarbaeva NV, Kovalevich LD. MSCT sings of neuroendocrine tumors of the lung and their relationship with ACTH-ectopic syndrome. REJR 2018; 8(4):56-72. doi: 10.21569/2222- 7415-2018-8-4-56-72(In Russ.)
  13. Belaya ZE, Golounina OO, Sitkin II, Rozhinskaya LY, Degtyarev MV, Trukhina DA, Lapshina AM, Bondarenko EV, Mamedova EO, Przhiyalkovskaya EG, Vaks VV, Melnichenko GA, Mokrysheva NG, Dedov II. Diagnostic value of bilateral inferior petrosal sinus sampling in various modifications and methods of radiation and radionuclide imaging in the diagnosis and differential diagnosis of ACTH-dependent endogenous hypercortisolism. Problems of Endocrinology. 2023;69(6):4-16. (In Russ.)
  14. Seastedt KP, Alyateem GA, Pittala K, Steinberg SM, Schrump DS, Nieman LK, Hoang CD. Characterization of Outcomes by Surgical Management of Lung Neuroendocrine Tumors Associated With Cushing Syndrome. JAMA Netw Open. 2021; 4(9): e2124739. doi: 10.1001/jamanetworkopen.2021.24739.
  15. Gao C, Zhang J, Wang Y, Huang C, Zhang Y, Chen Y, Li S. Patients with ectopic ACTH syndrome might have a better prognosis in bronchopulmonary carcinoids with lymph node metastasis received radical surgery: a single-centre retrospective study in the last 22 years in China. BMC Surg. 2022; 22(1): 383. doi: 10.1186/s12893-022-01831-5.
  16. Boddaert G, Grand B, Le Pimpec-Barthes F, Cazes A, Bertagna X, Riquet M. Bronchial carcinoid tumors causing Cushing’s syndrome: more aggressive behavior and the need for early diagnosis. Ann ThoracSurg. 2012;94(6):1823–29. doi: 10.1016/j.athoracsur.2012.07.022.
  17. Deb SJ, Nichols FC, Allen MS, Deschamps C, Cassivi SD, Pairolero PC. Pulmonary Carcinoid Tumors With Cushing’s Syndrome: An Aggressive Variant or Not? Annals of ThoracicSurgery 2005; 79(4): 1132–1136. doi: 10.1016/j.athoracsur.2004.07.021.
  18. Shrager JB, Wright CD, Wain JC, Torchiana DF, Grillo HC, Mathisen DJ. Bronchopulmonary carcinoid tumors associated with cushing’s syndrome: A more aggressive variant of typical carcinoid. J Thorac Cardiovasc Surg. 1997; 114(3): 367–375. doi: 10.1016/S0022-5223(97)70182-X
Address for correspondence:
115093, Moscow, Russian Federation,
Bolshaya Serpukhovskaya, st. 27,
National Medical
Surgery Research Center,
Named after A.V. Vishnevsky,
e-mail: pikunov@ixv.ru,
Pikunov Mikhail Y.
Information about the authors:
Pikunov Mikhail Y., PhD, leading researcher at the Department of Thoracic Surgery, National Medical Research Center for Surgery named after. A.V. Vishnevsky» of the Russian Ministry of Health of Russian Federation. Moscow, Russian Federation.
http://orcid.org/0000-0003-0559-4461
Pechetov Alexey A., PhD, Head of the Department of Thoracic Surgery, National Medical Research Center for Surgery named after. A.V. Vishnevsky» of the Russian Ministry of Health of Russian Federation. Moscow, Russian Federation.
http://orcid.org/0000-0002-1823-4396
Golounina Olga O., Clinical Resident of the State Scientific Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation. Moscow, Russian Federation.
https://orcid.org/0000-0003-2320-1051
Bondarenko Ekaterina V., PhD, Head of the Biobanking Group of the State Research Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation. Moscow, Russian Federation.
https://orcid.org/0000-0003-2122-2297
Belaya Zhanna E., MD, Head of the Department of Neuroendocrinology and Osteopathy, Professor of the Department of Endocrinology of the Institute of Higher and Additional Professional Education of the State Scientific Center of the Russian Federation, Federal State Budgetary Institution «National Medical Research Center for Endocrinology» of the Ministry of Health of Russian Federation, Moscow, Russian Federation.
http://orcid.org/0000-0002-6674-6441

E.P. BURLEVA, A.V. PESHKOV, S.A. TYURIN, S.M. BELENTSOV, M.A. MATVEEVA, M.E. ONOKHINA, I.O. OSEEV

LOWER LIMB VARICOSE VEIN RECURRENCES: STRUCTURE AND TACTICAL DECISIONS (A START-UP STUDY)

Federal State Budgetary Educational Institution of Higher Professional Education
"Ural State Medical University", Ministry of Health of the Russian Federation 1,
"Olmed" 2,
"AngioLine" 3, Ekaterinburg,
Russian Federation

Objective. Analysis of the structure of recurrences of varicose veins (VV) of the lower extremities and surgical tactics of their treatment.
Material and Methods. A retrospective analysis of the medical documentation of two phlebological centers during the period from 2020 to 2013 was carried out. 566 cases of recurrent VV in 504 patients were detected (78.8% of women; 21.2% of men; average age – 44.5 years). 2 groups were formed. In the 1st group - 285 cases, the first intervention in the GSV basin was phlebectomy (FE)\stripping; in the 2nd group – 245 – endovasal thermal ablation interventions (EVTI) (RFQ-103, EVLC – 142). The analysis of the material was based on a new classification of VV recurrences (ESVS guidelines, 2022).
Results. The recurrences of the disease after EVTI were detected in 271 cases (7.4%): 159 cases after EVLC (9.5%), 112 cases after RFQ (5.6%). The percentage of recurrences after phlebectomies was 10.4%. According to the analysis of the structure of recurrences, the percentage of technical and tactical errors after EVTI was 2.2%, after FE – 1.6%. The main part of recurrences was associated with the progression of VV and neovascularization on the high. New vertical overflows on the thigh were registered in 169 cases (57.3%) after FE and in 77 cases after EVTI (28.4%). In the EVTI group, a significant part of recurrences accrues to horizontal reflux – 102 cases (37.6%), in the FE group – 65 cases (22.0%). Recurrences associated with changes in the SSV basin: after EVTI – 11.8%, after FE – 10.4%. In a comparative analysis of the results of EVLC and RFQ, the difference was only in the percentage of medical errors (2.5% vs. 1.6%, respectively). Reinterventions (n=370) were performed in patients with venospecific complaints, recurrence of varicose syndrome, the presence of new refluxes in large tributaries with drainage into recanalized GSV or into another venous structures. EVLC and different variants of sclerotherapy were used. During 1-year observation, there were no complications or additional interventions, occlusion of the target veins was achieved.
Conclusion. Regardless of the type of surgical intervention on the stem of GSV, VV recurs in about 10% of patients. The pathological mechanisms of restructuring of the venous bed of the limb after phlebectomy \ stripping and EVTI were different. The use of minimally invasive endovasal interventions was a justified tactic for the treatment of recurrent VV.

Keywords: varicose veins of the lower extremities, endovasal laser coagulation, radiofrequency ablation, phlebectomy\stripping, reñurrences, classification, tactics
p. 374-382 of the original issue
References
  1. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, Katsamouris AN. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004 Mar;27(3):275-82. doi: 10.1016/j.ejvs.2003.12.006
  2. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004 Oct;40(4):634-39. doi: 10.1016/j.jvs.2004.07.003
  3. Zolotuhin IA, Andrijashkin AV, Kirienko AI. Recidiv varikoznoj bolezni nizhnih konechnostej: ponjatie, diagnostika i prichiny patologii. Angiologija i Sosudistaja Hirurgija. 2007;13(2):129-32. https://www.angiolsurgery.org/magazine/2007/2/19.htm (In Russ)
  4. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079-87. doi: 10.1002/bjs.7555
  5. Rasmussen L, Lawaetz M, Serup J, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord. 2013 Oct;1(4):349-56. doi: 10.1016/j.jvsv.2013.04.008
  6. Lawaetz M, Serup J, Lawaetz B, Bjoern L, Blemings A, Eklof B, Rasmussen L. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017 Jun;36(3):281-88. doi: 10.23736/S0392-9590.17.03827-5
  7. Hamann SAS, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR. Editor’s choice - five year results of great saphenous vein treatment: a meta-analysis. Eur J Vasc Endovasc Surg. 2017 Dec;54(6):760-70. doi: 10.1016/j.ejvs.2017.08.034
  8. Whing J, Nandhra S, Nesbitt C, Stansby G. Interventions for great saphenous vein incompetence. Cochrane Database Syst Rev. 2021 Aug 11;8(8):CD005624. doi: 10.1002/14651858.CD005624.pub4
  9. De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-67. doi: 10.1016/j.ejvs.2021.12.024
  10. Zubritskiy VF, Chernookov AI, Kuznetsov MR, Kandyba SI, Dolgov SI, Atayan AA, Ramazanov AA, Shadyzheva TI. Surgical tactics optimization for the treatment of patients with relapses of lower limb varicose veins RMZh. Med Obozrenie. 2023;7(4):225-31. doi: 10.32364/2587-6821-2023-7-4-225-231 (In Russ)
  11. Chernookov AI, Ramishvili VSh, Dolgov SI, Nikolaev AM, Ataian AA, Belykh EN. Sovremennaia strategiia lecheniia bol’nykh s retsidivami varikoznoi bolezni posle endovazal’nykh vmeshatel’stv. Med Novosti Gruzii. 2021;313(4):26-33. https://geomednews.com/ru/v313-april-2021.html (In Russ)
  12. Flessenkämper I, Hartmann M, Hartmann K, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology. 2016 Feb;31(1):23-33. doi: 10.1177/0268355514555547
  13. O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016 Jan;4(1):97-105. doi: 10.1016/j.jvsv.2014.11.004
  14. Karimian M, Tardeh Z, Mohammadi Y, Tardeh S. Efficacy of radiofrequency ablation (RFA) in the treatment of varicose veins: a systematic review and meta-analysis. Indian J Surg. 2022;85(2):56-62. doi: 10.1007/s12262-022-03613-y
  15. Perrin MR, Labropoulos N, Leon LR Jr. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006 Feb;43(2):327-34; discussion 334. doi: 10.1016/j.jvs.2005.10.053
  16. Brake M, Lim CS, Shepherd AC, Shalhoub J, Davies AH. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg. 2013 Mar;57(3):860-68. doi: 10.1016/j.jvs.2012.10.102
  17. Burleva EP, Tiurin SA, Peshkov AV. Ctripping vs endovazal’nye termoablatsionnye vmeshatel’stva pri varikoznoi bolezni: 5-letnie kliniko-gemodinamicheskie rezul’taty randomizirovannogo issledovaniia. Khirurg.2022;(9):28-40. doi: 10.33920/med-15-2205-04 (In Russ.)
  18. Winokur RS, Khilnani NM, Min RJ. Recurrence patterns after endovenous laser treatment of saphenous vein reflux. Phlebology. 2016 Aug;31(7):496-500. doi: 10.1177/0268355515596288
  19. Glass GM. Neovascularization in recurrence of the varicose great saphenous vein following transection. Phlebology. 1987;2(2):81-91. doi: 10.1177/026835558700200205
  20. Mouton W, Heim D, Janzen J. Neovascularization of saphenous veins. J Vasc Bras. 2019 May 7;18:e20190030. doi: 10.1590/1677-5449.190030
  21. Labropoulos N, Bhatti A, Leon L, Borge M, Rodriguez H, Kalman P. Neovascularization after great saphenous vein ablation. Eur J Vasc Endovasc Surg. 2006 Feb;31(2):219-22. doi: 10.1016/j.ejvs.2005.06.030
Address for correspondence:
620102, Russian Federation,
Ekaterinburg, Volgogradskaya st, 189,
MAU GKB No. 40
Tel: 8 912 600 300 8.
e-mail: e.p.burleva@gmail.com
Burleva Elena Pavlovna
Information about the authors:
Burleva Elena P., MD, Professor of the Department of Surgery, Endoscopy and Coloproctology of the Ural State Medical University, Cardiovascular Surgeon, Professor, Honored Doctor of the Russian Federation, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0003-1817-9937
Peshkov Andrey V., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed Network of Medical Centers, Yekaterinburg, Russian Federation.
http://orcid.org/ 0000-0002-9246-0463
Tyurin Sergey A., PhD, Cardiovascular Surgeon, Chief Physician of the Olmed MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0001-5125-4295
Belentsov Sergey M., MD, Professor, Cardiovascular Surgeon at the AngioLine MC, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0002-3742-8954
Matveeva Marina A., Cardiovascular Surgeon MC «Olmed», Ekaterinburg, Russian Federation.
https://orcid.org/0009-0009-6184-872Õ
Onokhina Margarita E., Clinical Resident of the Department of Surgery, Endoscopy and Coloproctology, Ural State Medical University.
https://orcid.org/0000-0003-4912-7996
Oseev Ilya O., Student of the Faculty of Treatment and Prevention of the Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University”, Ekaterinburg, Russian Federation.
https://orcid.org/0009-0000-1720-4649

REVIEWS

E.V. DENISENKO

RECTAL FISTULAS: CURRENT STATE OF THE PROBLEM, DIRECTIONS OF SURGICAL TREATMENT (LITERATURE REVIEW)

The Vitebsk Regional Clinical Specialized Centre,
The Vitebsk State Order of Friendship of Peoples Medical University, Vitebsk,
Republic of Belarus

Based on the literature data, an analysis of the current state of the problem of rectal fistulas is carried out in a comparative aspect: the causes of their occurrence, classification, and effectiveness of existing surgical treatment methods. The text database of medical and biological publications PubMed (based on the section «biotechnology» of the National Library of Medicine of the USA) was used through NCBI-Entrez access. The analysis of more than 450 sources of special medical literature was performed. Despite the presence of a huge number of techniques, both invasive, characterized by a high incidence of incontinence, and minimally invasive, the use of which is associated with a high risk of recurrence, diverse indicators of their effectiveness indicate that still the problem of rectal fistula and requires further search for more effective treatment methods.

Keywords: fistulas, rectum, surgical treatment, current problem
p. 383 of the original issue
References
  1. Shelygin IuA, red. Klinicheskie rekomendatsii. Koloproktologiia. 2-e izd., ispr i dop. Moscow, RF: GEOTAR-Media; 2020. 560 p. (In Russ.)
  2. Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.
  3. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011 Mar;24(1):14-21. doi: 10.1055/s-0031-1272819
  4. Parks AG. Pathogenesis and treatment of fistuila-in-ano. Br Med J. 1961 Feb 18;1(5224):463-69. doi: 10.1136/bmj.1.5224.463
  5. Seow-Choen F, Ho JM. Histoanatomy of anal glands. Dis Colon Rectum. 1994 Dec;37(12):1215-18. doi: 10.1007/BF02257784
  6. Herrmann GD, Desfosses L. La sur la muquese de la region cloacle du rectum. CR Acad Sci. 1880;111(90):1301-302.
  7. Toyonaga T, Matsushima M, Tanaka Y, Shimojima Y, Matsumura N, Kannyama H, Nozawa M, Hatakeyama T, Suzuki K, Yanagita K, Tanaka M. Microbiological analysis and endoanal ultrasonography for diagnosis of anal fistula in acute anorectal sepsis. Int J Colorectal Dis. 2007 Feb;22(2):209-13. doi: 10.1007/s00384-006-0121-x
  8. Kuz’minov AM, Borodkin AS, Volkov MV, Chubarov IuIu, Minbaev ShT. Rezul’taty khirurgicheskogo lecheniia ekstrasfinkternykh svishchei priamoi kishki putem nizvedeniia polnosloinogo segmenta stenki priamoi kishki v anal’nyi kanal. Koloproktologiia. 2004;(4):8-13. (In Russ.)
  9. van Onkelen RS, Mitalas LE, Gosselink MP, van Belkum A, Laman JD, Schouten WR. Assessment of microbiota and peptidoglycan in perianal fistulas. Diagn Microbiol Infect Dis. 2013 Jan;75(1):50-54. doi: 10.1016/j.diagmicrobio.2012.09.012
  10. Kiehne K, Fincke A, Brunke G, Lange T, Fölsch UR, Herzig KH. Antimicrobial peptides in chronic anal fistula epithelium. Scand J Gastroenterol. 2007 Sep;42(9):1063-69. doi: 10.1080/00365520701320489
  11. van Onkelen RS, Gosselink MP, van Meurs M, Melief MJ, Schouten WR, Laman JD. Pro-inflammatory cytokines in cryptoglandular anal fistulas. Tech Coloproctol. 2016 Sep;20(9):619-25. doi: 10.1007/s10151-016-1494-7
  12. Thiery JP, Acloque H, Huang RY, Nieto MA. Epithelial-mesenchymal transitions in development and disease. Cell. 2009 Nov 25;139(5):871-90. doi: 10.1016/j.cell.2009.11.007
  13. Lunniss PJ, Faris B, Rees HC, Heard S, Phillips RK. Histological and microbiological assessment of the role of microorganisms in chronic anal fistula. Br J Surg. 1993 Aug;80(8):1072. doi: 10.1002/bjs.1800800853
  14. Mitalas LE, Dwarkasing RS, Verhaaren R, Zimmerman DD, Schouten WR. Is the outcome of transanal advancement flap repair affected by the complexity of high transsphincteric fistulas? Dis Colon Rectum. 2011 Jul;54(7):857-62. doi: 10.1007/DCR.0b013e31820eee2e
  15. Seow-Choen F, Hay AJ, Heard S, Phillips RK. Bacteriology of anal fistulae. Br J Surg. 1992 Jan;79(1):27-28. doi: 10.1002/bjs.1800790107
  16. Wang D, Yang G, Qiu J, Song Y, Wang L, Gao J, Wang C. Risk factors for anal fistula: a case-control study. Tech Coloproctol. 2014 Jul;18(7):635-39. doi: 10.1007/s10151-013-1111-y
  17. Shelygin IuA, red. Klinicheskie rekomendatsii. Koloproktologiia. Moscow, RF: GEOTAR-Media; 2015. 528 p.
  18. Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum. 1984 Sep;27(9):593-97. doi: 10.1007/BF02553848
  19. Sileri P, Cadeddu F, D’Ugo S, Franceschilli L, Del Vecchio Blanco G, De Luca E, Calabrese E, Capperucci SM, Fiaschetti V, Milito G, Gaspari AL. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal. BMC Gastroenterol. 2011 Nov 9;11:120. doi: 10.1186/1471-230X-11-120
  20. Whiteford MH. Perianal abscess/fistula disease. Clin Colon Rectal Surg. 2007 May;20(2):102-9. doi: 10.1055/s-2007-977488
  21. Chernov AA, Zhukov BN, Isaev VR. Optimizatsiia khirurgicheskogo lecheniia bol’nykh so slozhnymi ekstra -i chrezsfinkternymi pararektal’nymi svishchami. Kazan Med Zhurn. 2007;88(6):604-605.( In Russ.)
  22. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976 Jan;63(1):1-12. doi: 10.1002/bjs.1800630102
  23. Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics. 2000;20(3):623-35.
  24. Whiteford MH, Kilkenny J 3rd, Hyman N, Buie WD, Cohen J, Orsay C, Dunn G, Perry WB, Ellis CN, Rakinic J, Gregorcyk S, Shellito P, Nelson R, Tjandra JJ, Newstead G; Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon Rectum. 2005 Jul;48(7):1337-42. doi: 10.1007/s10350-005-0055-3
  25. Garg P. Comparing existing classifications of fistula-in-ano in 440 operated patients: Is it time for a new classification? A Retrospective Cohort Study. Int J Surg. 2017 Jun;42:34-40. doi: 10.1016/j.ijsu.2017.04.019
  26. Jimenez M, Mandava N. Anorectal Fistula. In: StatPearls [Internet]. [ñited 2023 Dec 25]; Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560657/
  27. García-Botello S, Garcés-Albir M, Espi-Macías A, Moro-Valdezate D, Pla-Martí V, Martín-Arevalo J, Ortega-Serrano J. Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence. Langenbecks Arch Surg. 2021 Nov;406(7):2497-505. doi: 10.1007/s00423-021-02307-5
  28. Maqbool J, Mehraj A, Shah ZA, Aziz G, Wani RA, Parray FQ, Chowdri NA. Fistulectomy and incontinence: do we really need to worry? Med Pharm Rep. 2022 Jan;95(1):59-64. doi: 10.15386/mpr-2045
  29. Awad PBA, Hassan BHA, Awad KBA, Elkomos BE, Nada MAM. A comparative study between high ligation of the inter-sphincteric fistula tract via lateral Approach Versus Fistulotomy and primary sphincteroplasty in High Trans-Sphincteric Fistula-in-Ano: a randomized clinical trial. BMC Surg. 2023 Aug 9;23(1):224. doi: 10.1186/s12893-023-02117-0
  30. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Int J Colorectal Dis. 2009;11(6):564-71.
  31. Elnaim Ali ALK, Wong MP, Sagap I. The Value of Cutting Seton for High Transsphincteric Anal Fistula in the Era of Its Misery. Malays J Med Sci. 2022 Feb;29(1):55-61. doi: 10.21315/mjms2022.29.1.6
  32. 32. Anosov I.S. Lechenie prjamokishechnyh svishhej metodov i hperevjazki v mezhsfinkternom prostranstve: dis. kand. med. nauk: 14.01.17. Moscow, RF;2017.24 p.
  33. Emile SH, Khan SM, Adejumo A, Koroye O. Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: An updated systematic review, meta-analysis, and meta-regression of the predictors of failure. Surgery. 2020 Feb;167(2):484-92. doi: 10.1016/j.surg.2019.09.012
  34. Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011 Dec;15(4):417-22. doi: 10.1007/s10151-011-0769-2
  35. Emile SH, Elfeki H, Shalaby M, Sakr A. A Systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc. 2018 Apr;32(4):2084-93. doi: 10.1007/s00464-017-5905-2
  36. Garg P. Transanal opening of intersphincteric space (TROPIS) - A new procedure to treat high complex anal fistula. Int J Surg. 2017 Apr;40:130-134. doi: 10.1016/j.ijsu.2017.02.095
  37. Huang B, Wang X, Zhou D, Chen S, Li B, Wang Y, Tai J. Treating highly complex anal fistula with a new method of combined intraoperative endoanal ultrasonography (IOEAUS) and transanal opening of intersphincteric space (TROPIS). Wideochir Inne Tech Maloinwazyjne. 2021 Dec;16(4):697-703. doi: 10.5114/wiitm.2021.104368
  38. Zmora O, Mizrahi N, Rotholtz N, Pikarsky AJ, Weiss EG, Nogueras JJ, Wexner SD. Fibrin glue sealing in the treatment of perineal fistulas. Dis Colon Rectum. 2003 May;46(5):584-89. doi: 10.1007/s10350-004-6612-3
  39. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum. 2002 Dec;45(12):1608-15. doi: 10.1007/s10350-004-7247-0
  40. Swinscoe MT, Ventakasubramaniam AK, Jayne DG. Fibrin glue for fistula-in-ano: the evidence reviewed. Tech Coloproctol. 2005 Jul;9(2):89-94. doi: 10.1007/s10151-005-0204-7
  41. Herreros MD, Garcia-Arranz M, Guadalajara H, De-La-Quintana P, Garcia-Olmo D; FATT Collaborative Group. Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula Advanced Therapy Trial 1) and long-term evaluation. Dis Colon Rectum. 2012 Jul;55(7):762-72. doi: 10.1097/DCR.0b013e318255364a
  42. Malanga GA, Bemanian S. Microfragmented adipose injections in the treatment of knee osteoarthritis. J Clin Orthop Trauma. 2019 Jan-Feb;10(1):46-48. doi: 10.1016/j.jcot.2018.10.021
  43. Zhang Y, Ni M, Zhou C, Wang Y, Wang Y, Shi Y, Jin J, Zhang R, Jiang B. Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study. Stem Cell Res Ther. 2020 Nov 10;11(1):475. doi: 10.1186/s13287-020-01995-y
  44. Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, García-Granero E. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis. 2017 May;32(5):599-609. doi: 10.1007/s00384-017-2779-7
  45. Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula-in-ano with laser--FiLaC™: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis. 2014 Feb;16(2):110-5. doi: 10.1111/codi.12440
  46. Elfeki H, Shalaby M, Emile SH, Sakr A, Mikael M, Lundby L. A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol. 2020 Apr;24(4):265-74. doi: 10.1007/s10151-020-02165-1
  47. Dango S, Antonakis F, Schrader D, Radzikhovskiy A, Ghadimi MB, Hesterberg R. Long-term efficacy and safety of a nitinol closure clip system for anal fistula treatment. Minim Invasive Ther Allied Technol. 2017 Aug;26(4):227-31. doi: 10.1080/13645706.2017.1282521
  48. Wang Y, Wu Y, Wang Y, Jiang B, Zhou C, Zhang Y. A Disposable Nitinol Memory Alloy Anal Fistula Clip (AFC) for the Treatment of Cryptoglandular Fistula-In-Ano: a Prospective, Randomized, Controlled Study With Short-Term Follow-Up. J Gastrointest Surg. 2022 Oct;26(10):2224-26. doi: 10.1007/s11605-022-05355-4
  49. Göttgens KW, Vening W, van der Hagen SJ, van Gemert WG, Smeets RR, Stassen LP, Baeten CG, Breukink SO. Long-term results of mucosal advancement flap combined with platelet-rich plasma for high cryptoglandular perianal fistulas. Dis Colon Rectum. 2014 Feb;57(2):223-27. doi: 10.1097/DCR.0000000000000023
  50. Abdollahi A, Emadi E, Hamidi Alamdari D. Autologous platelet-rich-plasma injection and platelet-rich fibrin glue interposition for treatment of anal fistula resistant to surgery. Gastroenterol Hepatol Bed Bench. 2023;16(3):292-96. doi: 10.22037/ghfbb.v16i2.2719
  51. Song WL, Wang ZJ, Zheng Y, Yang XQ, Peng YP. An anorectal fistula treatment with acellular extracellular matrix: a new technique. World J Gastroenterol. 2008 Aug 14;14(30):4791-94. doi: 10.3748/wjg.14.4791
  52. Tao Y, Zheng Y, Han JG, Wang ZJ, Cui JJ, Zhao BC, Yang XQ. Long-Term Clinical Results of Use of an Anal Fistula Plug for Treatment of Low Trans-Sphincteric Anal Fistulas. Med Sci Monit. 2020 Dec 6;26:e928181. doi: 10.12659/MSM.928181
Address for correspondence:
210604, Republic of Belarus,
Vitebsk, Maxim Gorky str., 90 A/1,
Vitebsk Regional Clinical Specialized Centre,
Surgical Department,
tel.: +375 (29) 899-06-21,
e-mail: eduard_denisenko@list.ru,
Denisenko Eduard V.
Information about the authors:
Denisenko Eduard Valeryevich, Surgeon, Vitebsk Regional Clinical Specialized Centre, Vitebsk, Republic of Belarus.
http://orcid.org/0009-0002-4265-9885

M.D. LEVIN

THEORETICAL BASIS OF NEW SURGICAL TACTICS FOR ANORECTAL DEFECTS WITHOUT VISIBLE FISTULAS

X-ray Department of the 1st City Clinical Hospital, Minsk,
Republic of Belarus,
Dorot. Medical Center for rehabilitation and geriatrics. Netanya,
Israel

Recently, the diagnosis and surgical treatment of anorectal malformations (ARM) is based on the idea of the absence of the anal canal in these patients. The caudal part of the intestine, called the fistula or rectal pouch, is removed during all pull-through procedure. Poor results from these surgeries (fecal incontinence 16.7% to 76.7%; chronic constipation 22.2% to 86.7%; urinary incontinence 1.7% to 30.5%; ejaculatory dysfunction 15.6% to 41.2%; and erectile dysfunction 5.6% to 11.8%) are explained by the congenital absence of the anal canal. In the previous articles, we proved that these patients have a normally functioning anal canal. This was confirmed by the European Consortium. This paper provides a theoretical justification for new surgical interventions that preserve all the elements of the anal canal to exclude severe complications during ARM correction. In newborns, we offer a perineal perforation (PPP) procedure by inserting a needle into an open anal canal. The opening of the anal canal is performed under X-ray control due to compression of the abdomen. As a result of simple manipulations, a tracheostomy tube is inserted into the rectum, which is removed after 7 days. Diastasis between the intestine and the skin heals without the formation of fibrous tissue since there are no sutures between the intestine and the skin. In the presence of a colostomy, we recommend the method proposed by Pakarinen and Rintala. The anal canal is visualized within the intestinal lumen using retrograde flexible endoscopy through a previously performed sigmoid mucosal fistula. Perforation of the skin and subcutaneous tissue is performed with a special endoscope needle. After the same manipulations as in PPP, a tracheostomy tube is inserted into the rectum. Fecal retention and defecation did not differ from the norm after the use of PPP in several patients. This work substantiates the opportunity for clinical trials of the proposed methods.

Keywords: anorectal malformations without visible fistula; anal canal; X-ray diagnosis; surgical treatment; perineal perforation procedure; colostomy
p. 397-404 of the original issue
References
  1. Stephens FD. Imperforate rectum; a new surgical technique. Med J Aust. 1953 Feb 7;1(6):202-3.
  2. Levin MD. Anatomy and physiology of anorectum: the hypothesis of fecal retention, and defecation. Pelviperineology. 2021;40(1):50-57. doi: 10.34057/PPj.2021.40.01.008
  3. Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis. 2007 Jul 26;2:33. doi: 10.1186/1750-1172-2-33
  4. Elrouby A, Waheeb S, Koraitim A. Anterior sagittal anorectoplasty as a technique for the repair of female anorectal malformations: A twenty two-years-single-center experience. J Pediatr Surg. 2020 Mar;55(3):393-96. doi: 10.1016/j.jpedsurg.2019.04.008
  5. Zhou Y, Xu H, Ming A, Diao M, Sun H, Xie X, Li L. Laparoscopic-Assisted Anorectoplasty for Rectovestibular Fistula: A Comparison Study with Anterior Sagittal Anorectoplasty. Eur J Pediatr Surg. 2022 Oct;32(5):408-14. doi: 10.1055/s-0041-1740157
  6. Rigueros Springford L, Connor MJ, Jones K, Kapetanakis VV, Giuliani S. Prevalence of Active Long-term Problems in Patients With Anorectal Malformations: A Systematic Review. Dis Colon Rectum. 2016 Jun;59(6):570-80. doi: 10.1097/DCR.0000000000000576
  7. Rintala R, Lindahl H, Marttinen E, Sariola H. Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations. J Pediatr Surg. 1993 Aug;28(8):1054-58. doi: 10.1016/0022-3468(93)90518-p
  8. Levin MD, Averin VI, Degtyarev YuG. Pathological Physiology of Anorectal Malformations (ARM) Without Visible Fistulas. Literature Review Novosti Khirurgii. 2022 May-Jun; Vol 30 (3): 298-305
  9. Amerstorfer EE, Schmiedeke E, Samuk I, Sloots CEJ, van Rooij IALM, Jenetzky E, Midrio P, Arm-Net Consortium. Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences-The ARM-Net Consortium Consensus. Children (Basel). 2022 Jun 3;9(6):831. doi: 10.3390/children9060831
  10. Levin M.D. Pathological Physiology of Anorectal Malformations, from the new conception to the new method of treatment. Experim Clin Gastroenterology. 2013;11:38-48
  11. Pakarinen MP, Rintala RJ. Management and outcome of low anorectal malformations. Pediatr Surg Int. 2010 Nov;26(11):1057-63. doi: 10.1007/s00383-010-2697-z
  12. Pakarinen MP, Rintala RJ. Management and outcome of low anorectal malformations. Pediatr Surg Int. 2010 Nov;26(11):1057-63. doi: 10.1007/s00383-010-2697-z
Address for correspondence:
4220200, Dorot,
Amnon ve-Tamar 1, Israil
State Geriatic Center, Netanya,
tel.: +972 538281393,
e-mail: nivel70@hotmail.com,
Levin Mikhail D.
Information about the authors:
Levin Mikhail D. MD, Radiologist, State Gerriatric Center (Djrot), Netanya, Israil.
https://orcid.org/0000-0001-7830-1944

CASE REPORTS

V.N. CHERNIAKOV, E.A. LENIVKO, A.Y. TOLSTIK

CURRENT ASPECTS OF DIAGNOSTICS OF BILE CHOLEDOCHAL CYSTS. CLINICAL CASE FROM PRACTICE

Brest City Emergency Hospital, Brest,
The Republic of Belarus

The article describes a rare clinical case from practice. Choledochal cysts (type 4a) was firstly diagnosed in a 64-year-old woman who had been experiencing periodic abdominal pain and a number of other unpleasant gastrointestinal symptoms for many years, the cause of which remained unknown. The patient’s admission to the emergency hospital was associated with a sharp increase of the pain syndrome intensity and the sudden development of jaundice. Despite the completely nonspecific clinical picture, using a complex of current visualization methods the cause of this condition was identified - cystic dilatation of the choledochal cyst and the presence of choledocholithiasis. The stages of a diagnostic search, which make it possible to clarify the location, morphological type, and size of the cyst, which is decisive for the choice of treatment tactics and management of such patients are described; the high efficiency of therapeutic and diagnostic endoscopic techniques, which are today the leading minimally invasive interventions in the elimination of choledocholithiasis is demonstrated.

Keywords: choledochal cyst, choledocholithiasis, jaundice, magnetic resonance tomography, endoscopic retrograde cholangiopancreatography
p. 405-410 of the original issue
References
  1. Saxena R, Pradeep R, Chander J, Kumar P, Wig JD, Yadav RV, Kaushik SP. Benign disease of the common bile duct. Brit J Surg. 1988 Aug;75(8):803-6. doi: 10.1002/bjs.1800750828
  2. Edil BH, Cameron JL, Reddy S, Lum Y, Lipsett PA, Nathan H, Pawlik TM, Choti MA, Wolfgang CL, Schulick RD. Chole dochal cyst disease in children and adults: a 30-year singleinstitutional experience. J Am Coll Surg. 2008 May;206(5):1000-8. doi: 10.1016/j.jamcollsurg.2007.12.045
  3. Castro PT, Matos APP, Werner H, Daltro P, Fazecas T, Nogueira R, Júnior EA. Prenatal Diagnosis of Caroli Disease Associated With Autosomal Recessive Polycystic Kidney Disease by 3-D Ultrasound and Magnetic Resonance Imaging. J Obstet Gynaecol Can. 2017 Dec;39(12):1176-1179. doi: 10.1016/j.jogc.2017.04.041
  4. Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S, Pawlik TM. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg. 2014 Dec;219(6):1167-80. doi: 10.1016/j.jamcollsurg.2014.04.023
  5. Tadokoro H, Takase M. Recent advances in choledochal cysts. Open J. Gastroenterol. 2012 Nov;2:145-54. doi: 10.4236/ojgas.2012.24029
  6. Alonso-Lej F, Rever Jr WB, Pessagno DJ. Congenital choledochal cysts, with a report of 2, and an analysis of 94, cases. Int Abstr Surg. 1959 Jan;108(1):1-30.
  7. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal structure. J Hepatobilairy Pancreat Surg. 2003;10(5):340-4. doi: 10.1007/s00534-002-0733-7
  8. Mustakimov BKh. Common bile duct cyst - symptoms and treatment [Internet]. 2023 Oct 2 [cited 2023 Dec 15]. Available from: https://probolezny.ru/kista-holedoha/#2 (In Russ.)
  9. Atkinson HDE, Fischer CP, de Jong CHÑ, Madhavan KK, Parks RW, Garden OJ. Choledochal cysts in adults and their complications. HPB (Oxford). 2003;5(2):105-10. doi: 10.1080/13651820310001144
  10. Kim JY, Kim HJ, Han HY. A Case Report of an Unusual Type of Choledochal Cyst with Choledocholithiasis: Saccular Dilatation of the Confluent Portion of Both Intrahepatic Ducts. J Korean Soc Radiol. 2015 Oct;73(4):252-8. doi: 10.3348/jksr.2015.73.4.252
  11. Söreide K, Körner H, Havnen J, Söreide JA. Bile duct cysts in adults. Br J Surg. 2004 Dec;91(12):1538-48. doi: 10.1002/bjs.4815
  12. Choledochal Cyst. In: Kamaya A, Wong-You-Cheong J, Park HS, Lane BF, Vandermeer F, Maturen KE, Bhatt S, Foster BR, Sukumar SA, Wasnik AP, editors. Diagnostic Ultrasound: Abdomen and Pelvis. Elsevier. 2016, p. 324-7. doi: 10.1016/B978-0-323-37643-3.50067-0
  13. Fulcher AS, Turner MA. 75 - Magnetic Resonance Cholangiopancreatography. In: Gore RM, Levine MS., editors. Textbook of Gastrointestinal Radiology, 2-Volume Set (Fourth Edition), W.B. Saunders; 2015. p. 1325-39. doi: 10.1016/B978-1-4557-5117-4.00075-1
  14. Wang CL, Ding HY, Dai Y. Magnetic resonance cholangiopancreatography study of pancreaticobiliary maljunction and pancreaticobiliary diseases. World J Gastroenterol. 2014 Jun;20(22):7005-10. doi: 10.3748/wjg.v20.i22.7005
  15. Kamani L. Role of Endoscopic Retrograde Cholangiopancreatography in Benign Biliary Diseases [Internet]. Updates in Endoscopy. IntechOpen; 2023. Available from: doi: 10.5772/intechopen.108525
Address for correspondence:
224005, Republic of Belarus,
Brest, Lenin st., 15,
Brest City Emergency Hospital
tel.: +375 (29) 825-71-90,
e-mail: kate_len@mail.ru,
Lenivko Ekaterina A.
Information about the authors:
Chernyakov Vadim Nikolaevich, Endoscopist of the Highest Qualification Category, Head of the Endoscopic Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0005-2878-362X
Lenivko Ekaterina Aleksandrovna, Endoscopist of the First Qualification Category, Endoscopist of the Endoscopic Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0006-2282-1557
Tolstik Alexander Yurievich, Surgeon of the First Qualification Category, Surgeon of the First Surgical Department of the Brest City Emergency Hospital, Brest, Republic of Belarus.
https://orcid.org/0009-0002-9555-3793

A.Y. BADYOUKOV 1, V.M. BONDARENKO 1, N.V. KROTOVA 2

A CASE OF SUCCESSFUL TREATMENT OF BOTH KIDNEYS’ CYSTS WITH EXTRAVASAL COMPRESSION OF THE VENA CAVA INFERIOR

Vitebsk State Medical University, Department of Hospital Surgery with the Course of FPC and PC 1,
Vitebsk Regional Clinical Hospital 2, Vitebsk,
The Republic of Belarus

Objective. The purpose of this work is to demonstrate a clinical case of diagnosis and treatment of a patient with large cysts of both kidneys, one of which caused compression of the inferior vena cava.
Results. The case of a 66-year-old patient who was admitted for surgical treatment of the large cysts Bosniak II of both kidneys is described. A detailed study of the patient revealed a complication in the form of compression of the vena cava inferior by the kidney cyst, with moderate clinical manifestations. As a result of surgical treatment, surgical success has been achieved, both in terms of eliminating compression of the renal parenchyma and decompression of the inferior vena cava.
Conclusion. It is possible that the detection of large kidney cysts in patients on ultrasound should serve as an indication for a more thorough identification of complaints, a thorough physical examination, as well as a computed tomography with contrast or magnetic resonance imaging.

Keywords: renal cyst, clinical observation, injury of the renal parenchyma, vena cava inferior, laparoscopy
p. 411-418 of the original issue
References
  1. Eissa A, El Sherbiny A, Martorana E, Pirola GM, Puliatti S, Scialpi M, Micali S, Rocco B, Liatsikos E, Breda A, Porpiglia F, Bianchi G; European Section of Uro-Technology (ESUT). Non-conservative management of simple renal cysts in adults: a comprehensive review of literature. Minerva Urol Nefrol. 2018 Apr;70(2):179-92. doi: 10.23736/S0393-2249.17.02985-X
  2. Lopatkin NA, Ljul’ko AV. Anomalii mochepolovoj sistemy. Kiev, Ukraina: Zdorov’ja; 1987. 416 p.
  3. Zhu M, Chu X, Liu C. Effects of renal cysts on renal function. Arch Iran Med. 2022 Mar 1;25(3):155-60. doi: 10.34172/aim.2022.26
  4. Grantham JJ. Pathogenesis of renal cyst expansion: opportunities for therapy. Am J Kidney Dis. 1994 Feb;23(2):210-18. doi: 10.1016/s0272-6386(12)80974-7
  5. Warren KS, McFarlane J. The Bosniak classification of renal cystic masses. BJU Intl. 2005 May;95(Is 7):939-42. doi: 10.1111/j.1464-410X.2005.05442.x
  6. Bosniak MA. The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol. 1997 May;157(5):1852-53.
  7. Zhu M, Chu X, Liu Ch. Effects of renal cysts on renal function. Arch Iran Med. 2022 Mar 1;25(3):155-60. doi: 10.34172/aim.2022.26
  8. Iogansen JuA. Hirurgicheskaja taktika pri prostyh i parapel’vikal’nyh kistah pochek. V kn: Shabrov AV, Majmulov VG, red. Problemy ukreplenija zdorov’ja i profilaktika zabolevanij. S-Petersburg, RF: SPbGMA im II Mechnikova; 2004. p. 113-14. (Russ)
  9. Komjakov BK, Rutenburg GM, Iogansen JuA. Vybor metoda lechenija pri iro-styh i parapel’vikal’nyh kistah pochek. V sb tr: Sovremennye napravlenija v diagnostike, lechenii i profilaktike zabolevanij. S-Petersburg, RF: SPbGMA; 2004. Vyp. IV. p. 207-209. (Russ)
  10. Touloupidis S, Fatles G, Rombis V, Papathanasiou A, Balaxis E. Percutaneous drainage of simple cysts of the kidney: a new method. Urol Int. 2004;73(2):169-72. doi: 10.1159/000079699
  11. Thwaini A, Shergill IS, Arya M, Budair Z. Long-term follow-up after retroperitoneal laparoscopic decortication of symptomatic renal cysts. Urol Int. 2007;79(4):352-55. doi: 10.1159/000109722
  12. Atug F, Burgess SV, Ruiz-Deya G, Mendes-Torres F, Castle EP, Thomas R. Long-term durability of laparoscopic decortication of symptomatic renal cysts. Urology. 2006 Aug;68(2):272-75. doi: 10.1016/j.urology.2006.03.009
  13. Shao ZQ, Guo FF, Yang WY, Wang GJ, Tan SF, Li HL, He XF, Wang JM, Liu HJ, Xia SJ. Percutaneous intrarenal marsupialization of symptomatic peripelvic renal cysts: a single-centre experience in China. Scand J Urol. 2013 Apr;47(2):118-21. doi: 10.3109/00365599.2012.704942
  14. Tadayon A, A’Yanifard M, Mansoori D. Endoscopic renal cyst ablation. Urol J. 2004 Summer;1(3):170-73.
  15. Li EC, Hou JQ, Yang LB, Yuan HX, Hang LH, Alagirisamy KK, Li DP, Wang XP. Pure natural orifice translumenal endoscopic surgery management of simple renal cysts: 2-year follow-up results. J Endourol. 2011 Jan;25(1):75-80. doi: 10.1089/end.2009.0676
  16. Mao X, Xu G, Wu H, Xiao J. Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts. BMC Urol. 2015 Jun 6;15:48. doi: 10.1186/s12894-015-0042-5
  17. Zhao Q, Huang S, Li Q, Xu L, Wei X, Huang S, Li S, Liu Z. Treatment of Parapelvic Cyst by Internal Drainage Technology Using Ureteroscope and Holmium Laser. West Indian Med J. 2015 Jun;64(3):230-35. doi: 10.7727/wimjopen.2014.220
  18. Fish GW. Large Solitary Serous Cysts of the Kidney. JAMA. 1939;112:514-18.
  19. Skolarikos A, Laguna MP, de la Rosette JJ. Conservative and radiological management of simple renal cysts: a comprehensive review. BJU Int. 2012 Jul;110(2):170-78. doi: 10.1111/j.1464-410X.2011.10847.x
  20. Chung BH, Kim JH, Hong CH, Yang SC, Lee MS. Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst. BJU Int. 2000 Apr;85(6):626-27. doi: 10.1046/j.1464-410x.2000.00508.x
  21. Yu JH, Du Y, Li Y, Yang HF, Xu XX, Zheng HJ. CT-guided sclerotherapy for simple renal cysts: value of ethanol concentration monitoring. Korean J Radiol. 2014 Jan-Feb;15(1):80-86. doi: 10.3348/kjr.2014.15.1.80
  22. Skolarikos A, Laguna MP, de la Rosette JJ. Conservative and radiological management of simple renal cysts: a comprehensive review. BJU Int. 2012 Jul;110(2):170-78. doi: 10.1111/j.1464-410X.2011.10847.x
  23. Chung BH, Kim JH, Hong CH, Yang SC, Lee MS. Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst. BJU Int. 2000 Apr;85(6):626-27. doi: 10.1046/j.1464-410x.2000.00508.x
Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Prospect, 27,
Vitebsk State Medical University,
Department of Hospital Surgery
with the Course of FPC and PC,
e-mail: aleksandrbad66@gmail.com,
tel.: +375295988859,
Badyoukov Aleksandr Y.
Information about the authors:
Badyoukov Aleksandr Y., Assistant of the Department of Hospital Surgery with the Course of FPC and PC, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0004-6215-0407
Bondarenko Vladimir M., Associate Professor of the Department of Hospital Surgery with the Course of FPC and PC, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0006-4458-103X
Krotova Natalya V. Radiologist, X-ray department, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
https://orcid.org/0009-0009-5270-2147
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