Obesity remains one of the global problems of modern healthcare. Complications after bariatric surgery are a serious problem for this group of patients. This article reflects the results of the Second Consensus Conference, held on May 25, 2024 in St. Petersburg and fully devoted to the treatment of complications in bariatric patients. 99 bariatric surgeons participated in the consensus. Consensus was considered achieved when 70% of respondents agreed. The consensus determines the algorithm of actions in the development of complications in a bariatric patient and will allow surgeons who do not have specialized training and experience in the management of bariatric patients to provide effective and timely treatment.

Background. Bariatric surgery is an effective long-term treatment for obesity and associated metabolic disorders such as type 2 diabetes mellitus (DM), hypertension, dyslipidemia, and sleep apnea. Despite the fact that the safety and effectiveness of bariatric interventions has now been proven, like any other surgical intervention, it’s associated with complications. Objective. To assess the incidence of early complications and 10-day mortality in patients undergoing bariatric surgery in the Russian Federation. Material and methods. Information on the frequency of interventions performed, associated complications and mortality was obtained from the Russian National Bariatric Registry database, containing anonymized data of patients who underwent bariatric intervention in the period from 03/03/2004 to 04/12/2023. The analysis included patients aged 18—70 years who underwent primary surgery. In addition to assessing 10-day mortality rates and the frequency of early postoperative complications, a comparative analysis of the likelihood of developing complications depending on the class of obesity, the patient’s age and the presence of comorbid conditions was carried out. Results. The analysis included 33.627 patients. The 10-day postoperative mortality rate was 0.098%. The rate of early postoperative complications was 1.77% for all types of operations and groups of patients. Bleeding and leakage were the most common: up to 1.2% and 1.5%, respectively, depending on the type of operation. The frequency of their development was statistically significantly influenced by the patient’s age, gender, BMI and the presence of concomitant pathology. Conclusion. Minimal postoperative risks of complications were observed in patients after sleeve gastrectomy. The proportion of bleeding cases in this group did not exceed 0.8%, and the failure of the stapler line did not exceed 0.5%. The 10-day postoperative mortality rate after sleeve gastrectomy was 0.05%.

Until now, there has not been organized consensus for standardization in bariatric surgery In Russia. We present the results of the first Bariatric Surgery Consensus Conference conducted in Barnaul (March, 2023). A list of questions was proposed within 6 blocks: 1) general issues of bariatric surgery, 2) sleeve gastrectomy, 3) one-anastomosis gastric bypass («mini-gastric bypass»), 4) Roux-en-Y Gastric Bypass, 5) Single Anastomosis Duodenal Switch and other options for biliopancreatic bypass, 6) rare procedures. Consensus (>70% agreement) was reached for 51 out of 96 statements. Stratification by the level of expertise was carried out, and responses of the expert group were compared with responses of all participants.

Obesity is a global social and economic problem. The bariatric surgery is a most effective treatment for obesity. The presented clinical case demonstrates the usage of principles of enchanced perioperative rehabilitation for the preoperative preparation of a patient with super obesity and with severe obstructive sleep apnea and alveolar hypoventilation syndrome.A 54-year-old patient was hospitalized with complaints of obesity, impossibility of persistent weight loss conservatively, severe daytime sleepiness, frequent nocturnal awakenings (up to 8 times per night). The patient’s weight was 230 kg with a height of 157 cm (BMI 93.5 kg / m2). The examination revealed a syndrome of sleep apnea of mixed genesis of extremely severe degree, chronic night hypoxemia of an extremely severe degree. Preoperative preparation was performed in accordance with the program of enchanced perioperative rehabilitation. The duration of preoperative preparation was 19 days; weight loss — 40 kg (%WL -17,4), compensation of comorbidities was achieved as well. After that the patient underwent a laparoscopic sleeve gastrectomy. There were no complications in the postoperative period. Length of postoperative hospital stay was 6 days. At follow-up examination one year after surgery, body weight dropped from 230 to 153 kg (% WL-33.5), a significant improvement of the quality of life was achieved.The enchanced perioperative rehabilitation program can be successfully used as an effective method for preoperartive preparation of the patients with morbid obesity in combination with severe obstructive sleep apnea syndrome.and obesity hypoventilation. It can be a reasonable alternative to the standard program with preoperative intragastric balloon treatment. The use of this technique allows to increase the effectiveness of treatment of these high-risk patients, as well as to reduce the risk of perioperative complications.

Based on the definition of obesity as a chronic, recurrent disease characterized by excessive deposition of adipose tissue in the body, it is obvious and understandable that the effectiveness of treatment is low, when in 95% of cases, it is not possible to reduce body weight for a long-term period, and a significant part of patients tend to return to initial body weight already in the first year after cessation of therapy. When all diets, psychotherapy and other attempts, including drug treatment, do not bring a special positive result, bariatric surgery methods come to the doctor and the patient’s aid. To date, bariatric surgery has been recognized as the most effective and radical method of treating morbid obesity. Bariatric surgery can lead to impressive results in terms of weight loss and improved health outcomes for patients. This type of surgery has become widespread today, and the number of operations and specialists in this field is growing every year.

ЦЕЛЬ ИССЛЕДОВАНИЯ Выработать критерии отбора пациентов, условия для выполнения операции, оценить результаты сочетанных пластических корригирующих операций у пациентов после массивной потери веса, достигнутой в результате пилоросохраняющих модификаций билиопанкреатического шунтирования (БПШ). МАТЕРИАЛ И МЕТОДЫ В исследование включены 65 пациентов, которые были прооперированы по методике БПШ в модификации SADI (n=34) и Hess—Marceau (BPD-DS) (n=31) и которым впоследствии была проведена постбариатрическая пластическая операция (ПБПО) для коррекции объемов тела и птоза мягких тканей. Удовлетворенность пациента эстетическими и функциональными результатами операции оценивали по субъективному опроснику Likert scale. РЕЗУЛЬТАТЫ ПБПО в группе SADI выполнялась через 27,4±13,6 мес после БПШ, а в группе BPD-DS — через 27,9±14,9 мес. В группах SADI и BPD-DS соответственно 10 (29,4%) и 6 (19,4%) пациентам пластические операции были проведены в сочетании с реконструкцией ЖКТ. Сочетанные операции были проведены соответственно 28 (82,4%) и 23 (74,2%) пациентам в группах SADI и BPD-DS. Частота послеоперационных осложнений составила 26,5 и 45,2% в группах SADI и BPD-DS соответственно, большинство из них не потребовали пребывания пациентов в стационаре и регрессировали самостоятельно в течение 1—2 мес на фоне консервативной терапии. Для большинства пациентов были получены максимальные баллы при оценке контура, расположения послеоперационных рубцов и эстетики пупка. ЗАКЛЮЧЕНИЕ ПБПО является неотъемлемой частью лечебного процесса пациентов с морбидным ожирением и чаще проводится в виде сочетанных, комбинированных операций, может успешно применяться в сочетании с реконструктивными бариатрическими операциями без увеличения числа послеоперационных осложнений. Удовлетворенность пациентов результатами ПБПО достигает 95,6%.

Background: Obesity is one of the most significant risk factors for type 2 diabetes (T2D), but a large number of patients with morbid obesity maintain normal glycemia for a long time. There are no definite easy-to-measure clinical features that distinguish severely obese people who will or will not develop T2D. These features may be useful in clinical practice to predict T2D development in obese patients.Aims: We aimed to identify clinical features (lifestyle factors, obesity history, concomitant diseases) that may be associated with T2D in obese patients.Materials and methods: The study was conducted at single center during 2002 and 2017 and recruited patients with BMI≥30 kg/m2 who attended bariatric surgeon. Patients weight and height were assessed by the doctor, other features were obtained from the questionnaire: overweight and obesity history (age of onset, duration, family history of obesity), lifestyle factors, T2D and concomitant diseases medical history. Patients were divided into 2 groups with regard to the presence of T2D. Data analysis was performed with Statistica 13.3.Results: The study included 170 patients with known T2D and 528 patients without history of T2D and prediabetes. Both groups had similar gender structure, as well as current and peak BMI. There were no significant differences in overweight/obesity duration, obesity family history, lifestyle factors and smoking status of patients. Obese patients without T2D were younger than T2D patients at the time of T2D onset (median age 40 and 45 years respectively). Patients without T2D started to gain weight earlier than those with T2D (median age 17 and 25 years respectively) and reached their peak BMI during 1 year before study entry, while patients with T2D went through maximum weight previously. The frequencies of concomitant diseases didn’t differ between the groups with the exception of hypertension that started later in patients with T2D (median age 51 and 47 years in patients with and without T2D respectively); also patients with T2D had gastroesophageal reflux disease (GERD) and chronic back pain less often than patients without T2D with regard to age.Conclusions: Clinical features that distinguished obese patients with and without T2D were age at the start of overweight/ obesity and concomitant disease profile (hypertension, GERD, chronic back pain) at corresponding age.

ОРИГИНАЛЬНЫЕ СТАТЬИИсследование сывороточного уровня резистина у пациентов с морбидным ожирением И.Н.Бобкова 1 , С.С.Гуссаова 1 , Е

AIM:To estimate the parameters of glucose metabolism and to assess the secretion of incretins in patients after biliopancreatic diversion (BPD) for morbid obesity (MO) in the early and late postoperative periods. SUBJECTS AND METHODS:The prospective part of the investigation included 22 patients with a body mass index of 35.8 to 68.4 kg/m2 and type 2 diabetes mellitus (T2DM). All the patients were examined before, 3 weeks and 3 months after BPD. The retrospective part covered 23 patients who were examined after BPD for MO; the postoperative period was 4.7 [2.3; 7.2] years. A control group consisted of 22 healthy, normal weight volunteers. A 75-g oral glucose tolerance test was carried out in all the groups to study the levels of glucose, immunoreactive insulin (IRI), glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and glucagon at 0, 30, 60, and 120 min. RESULTS:T2DM patients showed improvement in glucose metabolism just 3 weeks after BPD; following 3 months, they had normalized fasting blood glucose levels (5.6 [5.0; 6.0] mmol/l). During 3 months, glycated hemoglobin decreased from 7.5 [6.6; 8.5] to 5.7 [5.3; 5.9]%. In the early period following BPD, there was an increase in basal and postprandial GLP-1 levels associated with the peak IRI concentration. In the late period after BPD, the enhanced secretion of IRI and GLP-1 persisted, which was followed by a reduction in postprandial glucose levels in 4 of the 23 patients. CONCLUSION:T2DM remission does not depend on weight loss in the early period after BPD. In this period, the significant improvement of glucose metabolic parameters in patients with obesity and T2DM is associated with elevated GLP-1 levels. The altered incretin response is a stable effect of BPD and remains in its late period.

We examined 292 patients (mean age 37,5±9,1 years) with morbid obesity (initial BMI 47,3±7,0 kg/m2), from which 72 patients had type 2 diabetes, before and after biliopancreatic diversion in Hess-Marceau modification, conducted from 2003 to 2010. Along with a significant and steady weight loss, the most important advantage of surgery is its high efficiency in treatment of disturbances in carbohydrate and lipid metabolism in patients with morbid obesity and associated type 2 diabetes and severe atherogenic dyslipidemia.

Most researchers support the important role of incretins, particularly glucagon-like peptide-1 in improving metabolic control in patients with type 2 diabetes after bariatric operations, mostly involving shunting. A positive effect of bariatric surgery for type 2 diabetes is known from numerous publications on the results of surgical treatment of morbid obesity and in this review we try to analyze the mechanisms of this effect.

Most researchers support the important role of incretins, particularly glucagon-like peptide-1 in improving metabolic control in patients with type 2 diabetes after bariatric operations, mostly involving shunting. A positive effect of bariatric surgery for type 2 diabetes is known from numerous publications on the results of surgical treatment of morbid obesity and in this review we try to analyze the mechanisms of this effect.

Despite the developed methods of diet therapy in obesity and a variety of pharmacotherapy drugs for type 2 diabetes up to 60% of patients cannot maintain weight loss within 5 years of observation and more than 60% of patients with type 2 diabetes do not achieve adequate diabetes control. With morbid obesity the efficacy of conservative therapy is only 5-10%. Bariatric surgery has demonstrated a significant potential in compensation of obesity-related disorders, including type 2 diabetes.

The use of intragastric balloons in patients with morbid obesity (BMI>40) and superobesity (BMI>50) as the only method of treatment did not prove its effectiveness because of high rates of disease relapses. The article presents data showing that the fist line body mass lowering therapy with intragastric balloon before proceeding to bariatric sugery is effective in 78% patients with superobesity in aspects of lowering surgical and anesthesiological risks. Stopping treatment at the point of removal of intragastric balloon is associated with high risk of recurrence of obesity and its comorbid conditions. The use of intragastric balloons in group of high risk patients optimizes the process of selection of candidates for surgical treatment among patients with superobesity