Novosti
Khirurgii

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Year 2019 Vol. 27 No 4

REVIEWS

F.SH. AKHMETZYANOV 1, 2, V.I. EGOROV 1, 2

CHRONIC PRESACRAL SINUS AS THE OUTCOME OF TOTAL MESORECTUMECTOMY IN RECTAL CANCER

Kazan State Medical University 1,
Republican Clinical Cancer Center 2, Kazan,
The Russian Federation

Total mesorectumectomy is a risk factor of development and formulation of pathological presacral sinuses. In the result of the rectum resection with total mesorectumectomy, the volumetric cavity is formed in the pelvisbounded by thebone structures. In case of accumulation of the liquid and blood in it, the risk of infection and the formation of presacral abscesses increases. If the pathological cavity does not heal during 12 months, such sinus is considered to be chronic. The chronic presacral sinus is formed in 5-9.5% of patients, those who underwent total mesorectumectomy. The main causes of development are neoadjuvantchemotherapy, high intraoperative bleeding, tumors of large size. The diagnostics includes the following instrumental methods: rectoscopy, proctography, magnetic resonance imaging of the pelvic organs. The basic methods of treatment in small sinuses are the application of fibrin glue and the EndoVac system. Fibringluecloses defects mechanically, stimulates proliferation of fibroblasts and provides matrix for the synthesis of collagen and for the processes of the wound healing. Fibrin glue is most often used as the final stage of the EndoVac system therapy, when a sponge, corresponding to the defect sizes, is placed in the abscess cavity, and is replaced every 48-72 hours. Treatment effectiveness is 66-100%. In the case of a large sinus, drained through a small defect in anastomosis or inefficiency of the EndoVac system, the method of endoscopic marsupialization is appropriate to be used. The given method allows saving the colorectal anastomosis. In patients with symptomatic presacral sinus in whom stoma reversionis impossible, transversal proctectomy with the cavity tamponade by greater omentum is advisable.

Keywords: total mesorectumectomy, colorectal anastomosis, anastomosis leak, anterior rectal resection, rectal cancer, chronic pelvis sinus
p. 435-442 of the original issue
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Address for correspondence:
420000, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology, X-ray Diagnostics and Radiotherapy,
Tel. +79274299671,
e-mail: drvasiliy21@gmail.com,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Surgery Clinic, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-4516-1997
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-6603-1390
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