ВОЗМОЖНОСТИ МЕТАБОЛИЧЕСКОЙ ХИРУРГИИ. ОПЫТ ПЕРВОЙ ТЫСЯЧИ ОПЕРАЦИЙ

Аннотация

The article presents the assessment results of efficacy of modern bariatric laparoscopic operation during 10 years of practice. This work analyzed the treatment results of 1018 operated patients at the period from 2007 to 2014. The laparoscopic regulated gastric bandage operation was performed in 275 (28, 8%) cases. The lapa roscopic longitudinal gastric resection (LLGR) was applied in 411 (43,1%) (231 operation used the developed modification and 180 used standard method). The laparoscopic gastric bypass surgery (LGBS) was carried out in 253 (26,5%) cases (56 used the developed modification and 197 used the Lontron modification). The laparoscopic biliopancreatic bypass surgery (LBBS) was made in 14 (1,4%) cases (11 used Hess Marceau Baltasar modifications and 2 - Fobi modification, 1 - Scopinaro operation). BIB was implanted in 65 (6,3%) cases. The diagnosis of metabolic syndrome had initially been established for 321 (31,5%) patients. The rest of the patients 697 (68,4%) have been operated for obesity of different degree. An initial body mass index (BMI) <35 kg/m² (28,5-34,2) was in 13 (1,3%) of these patients, who were followed-up for 3 years. All the patients were initially divided into groups with metabolic syndrome (MS) and obesity of different degree and subgroups according to operative treatment and in consideration of the sex, age (up to 40 or more than 40 years old). The efficacy of the operation was estimated in consideration of the sex, age, type of operation, different terms (initially, after 3 months, one year, three and five years) and earlier determined markers. The most remote term was 10 years. The individual features of the patient should be taken into account while choosing the «ideal candidate» for different methods of surgical treatment according to the results of given researches. The restrictive gastric operations have some limitations for an application. The laparoscopic regulated gastric bandage is reasonable to apply in young age female group with initial BMI not more than 43 kg/m². The operation isn’t rational in treatment of MS. The operation LLGR should be used in patients without MS and with IMT not more than 48 kg/ m² regardless the sex or age. The operation could be performed in young age group as the first stage of surgical treatment aimed to cure MS in conditions of high operative risks. Combined operations proposed an exceptional possibility in treatment of MS components and could be considered as alternative method for treatment of diabetes mellitus in strictly selected groups.