[Preoperative predictors of obesity recurrence after laparoscopic gastrectomy]. / Predoperatsionnye prediktory retsidiva ozhireniya posle laparoskopicheskoi prodol'noi rezektsii zheludka.

OBJECTIVE: To find the preoperative predictors of obesity recurrence. MATERIAL AND METHODS: We analyzed 81 patients with obesity who underwent laparoscopic sleeve gastrectomy. Patients were followed-up for 5 years and divided into 2 groups (64 (79.0%) patients were in the persistent weight loss group and 17 (21.0%) ones were in the obesity recurrence group). RESULTS: We tried to make a mathematical model for predicting obesity recurrence after bariatric surgery based on various parameters (age, height, weight, hemoglobin A1C, lipoprotein A, T3, T4, triglycerides, TSH, cholesterol, arterial hypertension, diabetes, metabolic syndrome, percentage of fat mass). We trained the following classification models: logistic regression, naive Bayes classifier, decision tree. None classifier provided sufficient prediction quality. This may indicate that these data do not allow predicting of obesity recurrence after sleeve gastrectomy. CONCLUSION: We failed to construct a mathematical model based on preoperative data of patients with obesity predicting recurrence in long-term period after sleeve gastrectomy.

[Effectiveness of laparoscopic bariatric surgery: gastric plication vs sleeve gastrectomy]. / Sravnitel'naya otsenka effektivnosti laparoskopicheskikh bariatricheskikh operatsii: gastroplikatsii i prodol'noi rezektsii zheludka.

OBJECTIVE: To evaluate an effectiveness of laparoscopic bariatric surgery - sleeve gastrectomy and gastric plication. MATERIAL AND METHODS: In 2017, laparoscopic gastric plication in 47 obese patients and sleeve gastrectomy in 108 patients were performed at the Askerkhanov Medical Center and Loginov Moscow Clinical Scientific Center. Patients with morbid obesity (BMI ≥40 kg/m2) and obesity grade II (BMI ≥35.0 kg/m2) with one of such comorbidities as hypertension, diabetes mellitus type II, sleep apnea, degenerative joint disease, cholelithiasis underwent surgical treatment. The first group consisted of 35 patients who underwent laparoscopic gastric plication, the second group - 87 patients after laparoscopic sleeve gastrectomy. Overweight loss, quality of life, and course of comorbidities were evaluated before surgery, in 12 and 24 months after surgery. MOS SF-36 questionnaire was used to assess the quality of life. RESULTS: Overweight loss after 24 months was 52.4±6.1% and 67.9±8.4% in the first and second groups, respectively (p=0.001). Quality of life after gastric plication is lower compared to sleeve gastrectomy. The greatest difference in favor of sleeve gastrectomy was obtained after 24 months regarding physical functioning (64.3±14.9 vs. 79.2±17.7; p=0.010) and emotional functioning (60.7±28.8 vs. 78.0±25.2; p=0.009). Regression of comorbidities after sleeve gastrectomy is more significant than after gastric plication. CONCLUSION: Gastric plication is less effective than sleeve gastrectomy. However, postoperative morbidity requiring redo surgery is lower after gastric plication.

[Impact of bariatric surgery on vitamin metabolisms in obese patients].

AIM: To investigate the impact of bariatric surgery (BS) on the level of vitamins in obese patients. SUBJECTS AND METHODS: One hundred obese patients (78 women and 22 men) aged 19 to 61 years were examined. Controlled gastric banding (CGB) was carried out in 20 patients (mean body mass index (BMI), 41.3 ± 8.2 kg/m2); gastric sleeve resection (GSR) in 40 patients, and gastric shunting (GS) in 40 (the mean BMI in these groups were 41.1 ± 17.8 and 45.9 ± 6.2 kg/m2, respectively). A control group consisted of 10 apparently healthy individuals (BMI, 24.9 ± 3.2 kg/m2). An enzyme immunoassay was used to determine the serum concentrations of vitamins B1, B2, B5, B6, B9, B12, C, and D, niacin, biotin, and retinol-binding protein (RBP) before and 1 year after surgery. RESULTS: All the three groups showed a considerable decrease in the levels of vitamins C, B5, B6, and D, and RBP both prior to and following BS. More than 50% of the patients who had undergone GSR had also a lower baseline niacin level. A year after CGB, GSR, and GS, the number of patents with deficiency of these vitamins remained the same or increased. The majority of patients with the same level of vitamin B2, niacin, and folic acid (FA) were observed to have its decrease a year postsurgery. The concentration of the other test vitamins was also reduced a year after all operations; however, it remained within the normal range. GS had no substantial impact on the concentrations of FA, vitamins B2, B12, B1, and biotin. The lower serum vitamin levels were not accompanied by clinical symptoms in most patients following BS. CONCLUSION: In 80% of the patients with obesity, the levels of vitamins C, B6, and D were decreased to a variable degree. After BS, there was a rise in the number of patients with low serum vitamin C, D, B6, B5, niacin, FA, and RBP concentrations, at the same time the number of patients with FA deficiency increased by more than twice. BS did not significantly affect the metabolism of vitamins B1 B2 B12, and biotin.