POSTOPERATIVE ANASTOMOSIS: STATUS OF THE PROBLEM AND PROSPECTS (literature review)

Anastomositis represents a complex pathophysiological cascade that combines inflammatory reactions, tissue damage, and profound impairments of regenerative processes. Mechanical factors, anastomotic ischemia, infectious contamination, and modifying factors are identified in the etiology of anastomositis. Diagnosis of anastomositis and developing strictures is based on the integrated use of instrumental and laboratory methods. Endoscopy (EGD, colonoscopy) is rightfully considered the "gold standard" for direct visual assessment of the anastomotic area. Treatment of anastomositis is complex and comprehensive, involving both general and local treatment. General therapy is aimed at supporting vital functions, eliminating infection, and promoting tissue regeneration. Local therapy involves direct interventions at the anastomotic area. Endoscopic treatment has become the mainstay of treatment for postoperative anastomositis and strictures, offering minimally invasive alternatives to reoperation. Balloon dilation remains the treatment of choice for relatively early stenoses. A promising approach is the use of regenerative agents and tissue engineering. Prevention of anastomositis involves improving surgical technique, using extramucosal sutures, preoperative patient selection and preparation, and adherence to postoperative protocols.