[Prevention of side effects and complications after operation for partial ileal bypass].

Side effects and complications of the application of partial ileal bypass used for dislipidemia were analyzed in 162 patients with atherosclerosis. It was shown, that the partial ileal bypass operation could lead to the development of series of undesirable side effects such as diarrhea, hypovitaminosis B12, off-state intestine enteritis. The application of modification of partial ileal bypass such as formation of ileo-ileoanastomosis 5-6 cm long near ileocecal valve with the maintenance of its functions disposed the diarrhea and minimized the risk of the development of hypovitaminosis B12 after operation. It is possible to prevent the development of enteritis of off-state loop of the small intestine by using microanastomosis between off-state and functioning iliac intestine. The partial ileal bypass operation didn't influence on body weight, wouldn't increase the risk of stone formation in the gallbladder and kidneys. The risk of the development of hypovitaminosis B12 is minimal after operation.

[Comparative results of various methods of surgical treatment of severe forms of metabolic syndrome].

The data about metabolic syndrome (MS), characteristic for interrelationship of the main pathogenetic factors, are adduced. Along with positive moments, the faults of conservative therapy for MS are described, the indications for surgical treatment performance were substantiated and the results of its application in 220 patients, suffering severe forms of MS, were analyzed.

[25 year experience with using surgical correction of dislipidemia in treatment of patients with atherosclerosis].

An analysis of results of using partial ileoshunting for the treatment of dislipidemia in 159 patients with atherosclerosis has shown that operation of partial ileoshunting has an obligatory, pronounced and lifelong lipidcorrecting effect. An antiatherogenic effect of the operation of partial ileoshunting is manifested as the improvement of the clinical course of the disease caused by atherosclerosis, by less number of thrombotic complications of atherosclerosis and less lethality from cardio-vascular diseases. At a longer follow-up period, the efficiency of partial ileoshunting as a means of secondary prophylactics of atherosclerosis is confirmed but in case of liquidation after operation of dislipoproteidemia.

[Long-term results of dyslipoproteinemia surgical correction in patients with obliterating atherosclerosis of the lower extremity].

An analysis of long-term (up to 20 years) results of performing operations of partial ileoshunting as a method of surgical correction of dislipoproteidemia in 49 patients with obliterating atherosclerosis of the lower extremity vessels has shown that operations of partial ileoshunting have a pronounced and stable lipid correcting effect. Decreased level of atherogenic lipids in blood improved the course of obliterating atherosclerosis of the lower extremity vessels. Worse long-term clinical results after partial ileoshunting were in a considerable degree due to the presence of residual dislipoproteidemia that resulted in additional medicamentous hypolipidemic therapy.

[Surgical treatment of severe forms of metabolic syndrome].

The authors analyze the components of the metabolic syndrome in patients with morbid obesity treated at the surgical department. The effects of a modified operation of jejunal-ileal shunt on the components of the metabolic syndrome were shown in 220 patients operated upon at the clinic of Faculty surgery of the Pavlov Medical Academy in St. Petersburg. The indications to the operative treatment of the metabolic syndrome were substantiated on the basis of etiopathogenesis. The estimation of long-term results of the operation of jejunal-ileal shunt in patients with the metabolic syndrome is given.

[The dynamics of the coronary bed state in patients with ischemic heart disease after surgical correction of dyslipoproteidemia].

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

[Dyslipoproteinemia and prognosis of the course of ischemic heart disease after coronary bypass]. / Dislipoproteinemiia i prognoz techeniia ishemicheskoi bolezni serdtsa posle koronarnogo shuntirovaniia.

The article deals with the observation of 88 patients with ischemic heart disease, 62 of them had coexistent dyslipoproteidemia. More pronounced atherosclerotic lesions of the coronary artery were found to develop in patients with dyslipoproteidemia influencing the degree of ischemic heart disease before coronary bypass. Within the period of 10 years after operation dyslipoproteidemia patients have 3.5 times higher risk of the development of myocardial infarction, more than 2 times higher risk of reappearance of stenocardia and death from cardiovascular diseases. Patients with dyslipoproteidemia have 2 times higher probability of generalization of the atherosclerotic process in patients with is chemic heart disease at later terms after coronary bypass.

[Long-term results of the use of different modifications of the partial ileal shunt operation in the treatment of patients with atherogenic dyslipoproteinemias]. / Otdalennye rezul'taty primeneniia razlichnykh modifikatsii operatsii chastichnogo ileoshuntirovaniia dlia lecheniia bol'nykh s aterogennymi dislipoproteidemiiami.

The article presents long-term (up to 20 years) results of performing the classical H. Buchwald operations and its various modifications in 145 patients. Creation of ileoileoanastomoses 5 cm from the ileocecal valve and a standard shunt of 250 cm of the ileum allowed to obtain a necessary and considerable (27% at an average) hypocholesterolemic effect and to eliminate diarrhea at the postoperative period.

[20 years' experience of treating patients with extreme forms of obesity]. / Dvadtsatiletnii opyt lecheniia bol'nykh s krainimi formami ozhireniia.

During 20 years 356 patients with morbid obesity of the III-IV degrees were operated on, 339 of them being subjected to jejunoileal shunting in the authors' modification. The developed measures for the selection of patients, preoperative preparation, anesthesia and operation technique allowed the amount of postoperative complications to be reduced from 15 to 5%. Long-term results were followed-up in 220 patients during 3-17 years. Stable loss of the body mass, regression of the diseases resulting from obesity were noted in 187 of these patients (85%). Electrolytic disorders were found in 16.8% of the patients. The reconstruction of the small intestine because of progressing hepatic insufficiency was performed in 16 patients. Less than 20% loss of the body mass was noted in 18 patients.

[Surgical treatment of recurrent goiter]. / Khirurgicheskoe lechenie retsidivnogo zoba.

The authors have analyzed and generalized their 20-years experience with surgical treatment of 247 patients with recurrent goiter. Among them 48 patients had recurrent toxic goiter and 199 patients had nontoxic goiter. Postoperative complications developed in 8.3% of the patients with recurrent toxic goiter and in 6% of the patients with nontoxic goiter. The overall postoperative lethality was 1.2%. Operative treatment is recommended by the authors for recurrent toxic and nontoxic goiter, conservative treatment with radioactive iodine is thought to be expedient for a repeated recurrence. For preventing recurrences of toxic and nontoxic goiter after the first operation the administration of small does of the thyroid hormones is considered to be expedient during 1.5-2 months.

[Combined operations in extreme forms of obesity]. / Sochetannye operatsii pri lechenii krainykh form ozhireniia.

The authors make an analysis of their experiences with combined operations for extreme forms of obesity in 93 patients. Indications to such operations were considered to be only the diseases which could cause complications of the early and late postoperative period. In spite of more pronounced signs of aggression the combined operations do not enhance frequency and severity of postoperative complications. Recommendations are given for the selection of anesthesia, the access and sequence of operation steps. Measures are proposed which allow the frequency of postoperative complications to be decreased from 59.8 to 29.8%.

[Work capacity and the factors limiting it in patients with III- to IV-degree obesity]. / Rabotosposobnost' i faktory, ee limitiruiushchie, u bol'nykh ozhireniem III--IV stepeni.

There is a marked decrement in physical performance of those patients with III to IV grade obesity as compared to apparently healthy volunteers going into training. Deficient reserve capabilities of the system for utilization of oxygen and oxygen transport appear to be those factors determining and limiting physical fitness of obese individuals. Exercise testing involving recording of indices for gas exchange in real time appears to be a valuable method of diagnosis of particular features of oxygen supply in patients with III to IV grade obesity, providing a very helpful information.

[Jejunoileal bypass in the prevention and treatment of clinical manifestations of atherosclerosis in patients with morbid obesity]. / Eiunoileoshuntirovanie v profilaktike i lechenii klinicheskikh proiavlenii ateroskleroza u bol'nykh s rezko izbytochnoi massoi tela.

Jejunoileostomy effects on blood lipids and cardiovascular system were investigated in obese patients. They were found to lose 30% of their body mass within 6 postoperative months with parallel reduction in concentrations of total cholesterol, triglycerides, LDL and VLDL cholesterol and apoprotein B. These changes persisted for 4.5 years of the follow-up. The surgery in males has a more pronounced effect on blood lipids than in females. Significant changes were not registered in post- and preoperative levels of HDL cholesterol and apolipoprotein A-1. Jejunoileostomy promoted a fall in blood pressure, a rise in exercise tolerance, alleviation of atherosclerosis symptoms.

[Effects of jejunoileal shunting operation on the blood circulation system in patients with morbid obesity]. / Vliianie operatsii eiunoileoshuntirovaniia na sistemu krovoobrashcheniia u bol'nykh s ozhireniem krainei stepeni.

With the use of radiocardiography, the indices of central hemodynamics were studied in 22 patients with III-IV degree morbid obesity who underwent the operation of jejunoileal shunting. A special attention should be paid to the state of the patients within the first 18 months after the operation, because at this period, reformation of the cardiovascular system is most pronounced. The formulas for prediction of the state of the central hemodynamics at the late postoperative period are suggested.

[The partial ileal bypass in the treatment of familial hypercholesterolemia]. / Chastichnoe ileoshuntirovanie v lechenii semeinoi giperkholesterinemii.

Data on the influence of a partial ileal bypass on the level of lipids in 8 patients with a heterozygous variant of familial hypercholesterolemia are presented. The operation was followed by a decreased concentration of circulating cholesterol at the expense of cholesterol of low density lipoproteins, but the normalization of the lipid level in blood took place in 1 case only. To improve the results of treatment it is expedient to administer inhibitors of cholesterol synthesis in the postoperative period.