INTRODUCTION: Postoperative constipation (PC) in patients with imperforate anus and perineal fistula (PF) has been reported in up to 60%. Histological studies of PF revealed innervation anomalies which seem to be one of the reasons for PC. Perioperative histologically controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP). MATERIALS AND METHODS: A total of 665 patients with anorectal malformations underwent surgery between 1991 and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH Tetrazolium-reductase histochemical method were used. Four and more ganglion cells in the myenteric plexus represented a sufficient length of the resection. The continence was scored according to the modified Krickenbeck scoring system. Final scores ranged from 1 to 7 points. Values are given as median. RESULTS: A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile range [IQR]: 20-30). The median total continence score was 7 (IQR: 6-7). Post-op constipation was observed in 6/92 (6.5%) patients. CONCLUSION: PHCFR diminished PC to 6.5% of patients.

• MeSH
• anální atrézie * chirurgie   MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• perineum chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• předškolní dítě MeSH
• rektální píštěl * chirurgie   MeSH
• rektum chirurgie   abnormality   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• zácpa etiologie   chirurgie   MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE: To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS: Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS: The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION: MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

• Klíčová slova
• Anorectal malformation, Distal colostogram, Fluoroscopy, Infant, Magnetic resonance imaging, Male, Rectovesical fistula,
• MeSH
• anorektální malformace * diagnostické zobrazování   chirurgie   MeSH
• kolostomie MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie MeSH
• magnetická rezonanční tomografie metody   MeSH
• rektální píštěl * chirurgie   MeSH
• rektum diagnostické zobrazování   chirurgie   abnormality   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: It is still unclear if pathological complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients treated for rectal cancer causes worse postoperative outcomes, especially after transanal total mesorectal excision (TaTME). Worse postoperative outcomes might be an argument for an organ preserving watch and wait strategy in fragile patients and patients with comorbidities. The aim of this study is to evaluate whether patients treated for rectal cancer who had pCR to neoadjuvant therapy develop worse postoperative outcomes after TaTME than patients without complete response. METHODS: Comparative retrospective analysis (with nearest neighbor matching algorithm) of postoperative outcomes in two groups of patients, with pCR, n = 15 and without pCR (non-pCR), n = 57. All patients were operated on only by one surgical approach, TaTME, for middle and distal rectal tumors. All procedures were performed by one surgical team between 2014 and 2020 at the University Hospital Brno in Czech Republic. RESULTS: Overall morbidity was comparable between the groups (pCR group - 53.8% vs. non-pCR - 38.6%, p = 0.381). Anastomotic leak (AL) was observed in 33.3% of patients with pCR and in 17.5% of patients in the non-pCR group without statistical significance (p = 0.281). CONCLUSION: In conclusion, pathological complete response after neoadjuvant therapy does not appear to affect postoperative morbidity in rectal cancer after TaTME. Therefore, in patients with complete response who are not adherent to W&W surveillance, surgical resection can be perform without increased postoperative complications.

• Klíčová slova
• Anastomotic leak, Neoadjuvant therapy, Pathological complete response, Postoperative outcomes, Transanal total mesorectal excision,
• MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• morbidita MeSH
• nádory rekta * chirurgie   patologie   MeSH
• neoadjuvantní terapie MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• rektum chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Surgical treatment is the most important part of multimodal management of rectal cancer. In recent years, minimally invasive surgery has been preferred. Minimally invasive procedures include laparoscopy and more recently robotic surgery. Robotic surgery has been developed to eliminate the shortcomings of laparoscopy, especially the parallel position of instruments and their limited movement. The advantages of a robotic system should be most apparent in narrow and deep spaces, i.e. the lesser pelvis. The aim of this study was to analyze the short-term results of robot-assisted surgery for rectal tumors. METHODS: The study is a retrospective analysis of a cohort of 220 patients with robotic-assisted surgery for rectal cancer. The cohort was analyzed in terms of length of surgery, blood loss, number of conversions to open surgery, completeness of TME, distal and circumferential resection margin positivity, length of hospital stays and number of 30-day rehospitalizations. In addition, 30-day postoperative morbidity and mortality were assessed using the Clavien-Dindo score. RESULTS: Robotic-assisted surgeries lasted an average of 184 minutes. In total, 5 operations were converted, i.e. 2.3%. Complete mesorectum was achieved in 90% of the patients. Severe postoperative complications, Clavien-Dindo score 3-4, were observed in 14% of the patients. Anastomotic complications occurred in 9.6% of the patients. The mean length of the hospital stay was 8.4 days. CONCLUSION: Robotic surgery for rectal tumors is a safe method with an acceptable rate of complications. An established training method and a high degree of standardization of the surgical procedures are indisputable advantages of robotic systems, making it possible to achieve very good results in a short time. In terms of perioperative and early postoperative outcomes, robotic surgery outperforms laparoscopic surgery in some parameters.

• MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• nádory rekta * chirurgie   patologie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The rate of colorectal trauma is 5-10 % in modern war conflicts. The most common causes include gunshots or shrapnel injuries; the contusion-laceration mechanism occurs in sporadic cases in the war zone. Despite modern surgical procedures, however, it is associated with a high rate of morbidity, especially if it is not diagnosed and treated in time. Surgical management is specified by simple scoring schemes - the colon injury scale, rectal injury scale and the Flint grading system. Colonic resection with primary or delayed anastomosis is not associated with a higher risk of complicated healing and is nowadays preferred over the construction of terminal stomas. These are indicated only for cases with severe hemodynamic instability in traumatic-hemorrhagic or septic shock with severe diffuse peritonitis. Trauma to the intraperitoneal segment of the rectum is treated in the same way as trauma to the colon. An extraperitoneal rectal injury without soft tissue devastation can be treated with or without a transanal suture. On the contrary, devastating injuries to the rectum including the pelvic soft tissues should be primarily controlled with a stoma with delayed reconstruction. Presacral drainage or rectal stump lavage are no longer recommended.

• Klíčová slova
• colon injury, penetrating abdominal injury, rectal injury, war injury,
• MeSH
• anastomóza chirurgická MeSH
• chirurgické stomie * MeSH
• kolon MeSH
• kolorektální nádory * MeSH
• lidé MeSH
• poranění břicha * chirurgie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The treatment of locally advanced rectal cancer is multimodal. It includes neoadjuvant chemoradiotherapy (NCHRT). NCHRT has been shown to reduce the risk of local recurrence. New treatment regimens also have a positive impact on patient survival. NCHRT leads to fibrotic changes in the pelvis and is associated with side effects. NCHRT may have a negative impact on postoperative complications. The aim of this study was to demonstrate whether NCHRT increases the number of early postoperative complications. METHODS: An analysis of our own cohort of 200 patients with rectal cancer undergoing robotic-assisted surgery between 2018 and 2022 was performed. The cohort was divided into patients who underwent NCHRT and subsequently surgery and patients who underwent primary surgery. The two groups were compared in terms of duration of surgery, blood loss, incidence of anastomotic complications, and quality of mesorectal excision. RESULTS: Patients who underwent NCHRT had a longer operation time, by 34 minutes on average. We did not demonstrate a higher incidence of anastomotic complications in these patients. Patients who underwent primary surgery had a slightly lower blood loss and better quality of mesorectal excision during surgery. Nevertheless, complete or nearly complete mesorectal anastomosis was achieved in more than 85% of cases in both groups. CONCLUSION: Radiotherapy results in postradiation changes in the lesser pelvis. These changes impair visibility and dissection during surgery. Operations after NCHRT are more technically demanding and take longer but do not have more anastomotic complications. Also, the quality of mesorectal excision is satisfactory in both groups.

• Klíčová slova
• Chemoradiotherapy, complications, concurrent chemoradiotherapy, neoadjuvant treatment, rectal cancer, surgery,
• MeSH
• lidé MeSH
• nádory rekta * chirurgie   patologie   MeSH
• neoadjuvantní terapie škodlivé účinky   MeSH
• pooperační komplikace MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony * MeSH
• staging nádorů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Bowel obstruction is one of the most common postoperative complications in pelvic surgery. In most cases, adhesive mechanical ileus of the small bowel is the cause. In procedures such as Hartmann's resection or abdominoperineal rectal resection, it seems that the large wound area on the pelvic walls and pelvic floor and the dead space after the removed rectum with mesorectum contribute to the ileus condition. The aim of this paper was to identify the risk factors for ileus after selected pelvic procedures and to map the possible ways of prevention and treatment of these complications. METHODS: We performed retrospective simple analysis of a set of 98 patients who underwent elective abdominoperineal resection of the rectum, pelvic exenteration or Hartmann's resection for rectal cancer between 2017-2022. Postoperative complications were recorded, especially bowel obstruction, and perineal wound or rectal stump healing complications. In all 9 patients, who needed reoperation, we searched for risk factors for ileus known from the literature. We also described the management of ileus. RESULTS: In the group of 9 patients subjected to detailed analysis, 8 risk factors were most common: male gender, obesity, history of radiotherapy, open surgery, requirement of adhesiolysis in primary surgery, large blood loss, difficult dissection, and impaired healing of the rectal stump/perineum. A total of 8 (88.9%) patients had a combination of 4 or more of the mentioned risk factors. CONCLUSION: Our results confirm the impact of risk factors known from the literature; furthermore, they indicate a connection with the formation of a dead space in the pelvis and with complications of the rectal stump or perineal wound healing. Some of the risk factors cannot be changed, and current preventive measures cannot completely prevent the formation of adhesions. It is therefore advisable to look for other materials and methods that would ideally limit the formation of adhesions and at the same time fill the dead space and thus separate it from the perineal wound.

• Klíčová slova
• Hartmann ́s resection, abdominoperineal rectal resection, dead space, postoperative ileus, small bowel obstruction,
• MeSH
• ileus * etiologie   MeSH
• lidé MeSH
• nádory rekta * chirurgie   radioterapie   MeSH
• pánev MeSH
• perineum chirurgie   MeSH
• pooperační komplikace etiologie   MeSH
• rektum chirurgie   MeSH
• retrospektivní studie MeSH
• střevní obstrukce * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The aim of this experimental study was to test the method of prevention of postoperative complications, especially infectious, in partial dehiscence following stapler anastomosis in rectal surgeries. METHODS: The method includes the application of a hyaluronic acid-based gel in combination with triclosan, which has antibacterial properties. The gel was applied to the space around the rectum with an artificial, precisely defined dehiscence so that the dehiscence was separated from the rest of pelvis and the peritoneal cavity to avoid the spread of infection. The study included 30 female pigs. The rectosigmoid colon was mobilized and transected completely. Anastomosis was constructed with circular staplers. A perforator was then used to create precisely defined artificial dehiscence. Subsequently the lesser pelvis was filled with hyaluronic gel such that the site of artificial dehiscence was covered completely. RESULTS: All animals survived for 14 days until the second-look revision with no signs of failure in the anastomosis healing, local inflammation, and sepsis or postoperative complications, such as chills, refusal of liquid or feed, abdominal distension, and bowel obstruction. CONCLUSION: Hyaluronic acid applied as a precursor solution around the rectal anastomosis fills the lesser pelvis perfectly. It prevents the leakage of intestinal contents in the lesser pelvis. Triclosan as an antibacterial substance prevents the spread of inflammation in the pelvis or even in the abdominal cavity.

• Klíčová slova
• Dehiscence, Hyaluronic acid, Rectal surgery, Triclosan,
• MeSH
• anastomóza chirurgická metody   MeSH
• antibakteriální látky terapeutické užití   MeSH
• kyselina hyaluronová MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy MeSH
• pánev chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• prasata MeSH
• rektum chirurgie   MeSH
• triclosan * MeSH
• zánět MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH
• kyselina hyaluronová MeSH
• triclosan * MeSH

BACKGROUND: Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS: A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS: Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION: In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.

• Klíčová slova
• Anastomosis, Closure, Dehiscence, New techniques,
• MeSH
• anastomóza chirurgická metody   MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy etiologie   chirurgie   MeSH
• prasata MeSH
• rektum chirurgie   MeSH
• sepse * MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019-October 2020. The mean age of patients was 61 years (lower-upper quartiles 54-69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower-upper quartiles 3.00-4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien-Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

• Klíčová slova
• Anastomotic dehiscence, Low anterior resection, Rectal cancer,
• MeSH
• anastomóza chirurgická MeSH
• drenáž MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• netěsnost anastomózy MeSH
• pilotní projekty MeSH
• rektum * chirurgie   MeSH
• retrospektivní studie MeSH
• sliznice MeSH
• vakuum MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH