[Changes in metabolic parameters and glomerular filtration rate in patients with morbid obesity after bariatric surgery].

AIM: To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity. MATERIALS AND METHODS: We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared. RESULTS: In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed. CONCLUSION: Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.

[One-anastomosis gastric bypass with a short limb]. / Zheludochnoe shuntirovanie s odnim anastomozom na korotkoi petle.

OBJECTIVE: To develop an acceptable method of surgical treatment of patients with obesity grade 1 and 2 in accordance with the following criteria: high safety, no risk or minimal risk of intestinal malabsorption, no limitations for postoperative gastrointestinal examination, no need for organ resection and surgical reversibility in case of necessity. MATERIAL AND METHODS: In accordance with the above-mentioned criteria, we have modified OAGB (one-anastomosis gastric bypass). A gastric tube was formed from a lesser curvature using 33Fr stomach catheter with a length of at least 25 cm. Manual retrogastric retrocolic anastomosis in «end-to-side¼ fashion was performed within 20 cm from the ligament of Treitz. This type of anastomosis made it possible to preserve gastric tube length as much as possible that reduces the risk of jejunogastroesophageal reflux. RESULTS: There were 16 patients (15 females and 1 male) aged 23-48 years for the period from June 2019 till March 2020. Mean weight of patients was 86.12 kg (range 62-124). Mean BMI was 35.15 kg/m2 (ranged 21.96-39.62). In 6 months after surgery, all patients achieved normal BMI. Man BMI dropped to 23.8 kg/m2. Minimal excessive weight loss was 81.8%, maximal excessive weight loss - 125%. Control esophagogastroduodenoscopy was performed in 5 patients after 6 months and later. During retrograde duodenoscopy, we visualized major duodenal papilla in all cases using a flexible endoscope with standard optic system. CONCLUSION: The proposed modification of one-anastomosis gastric bypass with a short limb is a safe and effective procedure in bariatric surgery. This surgery ensures postoperative diagnostic and therapeutic endoscopic procedures in all parts of stomach and duodenum. This method could be recommended for surgical treatment of patients with obesity grade 1 and 2 after additional clinical trials and analysis of long-term results.