[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.

[Laparoscopic surgery in tumor obstruction of the biliary tract]. / Laparoskopicheskaia khirurgiia pri opukholevoi obstruktsii zhelchnykh putei.

The article gives a detailed description of the technique of laparoscopic biliodigestive anastomoses in patients with advanced tumors of hepatopancreatoduodenal zone. The authors have an experience with 18 operations. They performed 14 cholecystoenteroanastomoses including 9 total laparoscopic operations and 5 operations through a combined approach--laparoscopy in combination with minilaparotomy. The authors believe that laparoscopic surgery is feasible and safe for treatment of these patients. The combined approach has financial advantages giving the possibility to save the disposable stapling devices.

[Endoscopic removal of the gallbladder mucosa after cholecystostomy]. / Endoskopicheskoe udalenie slizistoi obolochki zhelchnogo puzyria posle kholetsistostomii.

The authors have developed a new method of radical treatment of patients with acute obstructive cholecystitis after cholecystostomy. The endoscopic removal of the mucosa was proposed using hysteroresectoscope GYI-525-12 (Circon-ACM1). The method was used in 5 elderly patients with high anesthesia risk in whom surgical cholecystectomy was not possible. The removal of the mucosa resulted in the replacement of the gallbladder with the connective tissue giving the effect of radical operation.

[Video endoscopy of the residual cavity in hydatidectomy of the liver]. / Endovideoskopiia ostatochnoi polosti pri ékhinokokkéktomii pecheni.

Results of treatment of 162 patients with echinococcosis of the liver were analyzed. Traditional surgical treatment of these patients was followed by endovideoscopy of the residual cavity of the liver. During endovideoscopy of the residual cavities the remnants of the chitinous membranes and small daughter vesicles not noticed during the open stage of the operation were removed in 7.4% of the patients, in 25.9% of the patients cystobiliary fistulas were detected. The endovideoscopy considerably improves revision of the residual cavities of the liver and facilitates liquidation of cystobiliary fistulas which gives better results of the treatment of such patients.

Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery. A pilot study.

BACKGROUND: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory parameters in patients with pneumoperitoneum (PP). METHODS: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous circulation disturbances, as well as the medical effect of the intermittent sequential compression device. RESULTS: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients >/=60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of >10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal pressure, was 47 +/- 10 at baseline, and 29 +/- 4 (p > 0.05) at both PPP and real PP (14 mmHg). CONCLUSIONS: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics in laparoscopic surgery.

[Treatment of peptic ulcer hemorrhage with leucine enkephalin analog dalargin]. / Lechenie iazvennykh gastroduodenal'nykh krovotechenii s primeneniem analoga leitsin--enkefalina-dalargina.

The article discusses treatment of 72 patients suffering from duodenal ulcer complicated by bleeding with the Soviet-made preparation Dalargin which is a synthetic analogue of leucine-enkephalin. The preparation was infused intravenously in a dose of 3 mg in physiological solution once daily. No other additional antiulcerative agents were give. The diagnosis was established on the basis of endoscopy. Dalargin led to cicatrization of the ulcers in 20.3 days in 60% of patient, obvious positive dynamics was noted in 32% of patients; in 8% of patients Dalargin proved ineffective. Basal hydrochloric acid secretion reduced by 56% during treatment.