[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity]. / Ispol'zovanie reguliruemogo silikonovogo bandazha pri gorizontal'noi gastroplastike u bol'nykh morbidnym ozhireniem.

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.

[Plastic surgery in patients with obesity late after horizontal banded gastroplasty]. / Plasticheskie operatsii u bol'nykh ozhireniem v otdalennye sroki posle gorizontal'nli gastroplastiki.

The results of 361 plastic operations in 296 patients with morbid obesity late after horizontal gastroplasty were analyzed. Plastic and corrective operations aimed at removal of redundant lipocutaneous "aprons" at the anterior abdominal wall, thighs, thoracic wall, gluteal region and the arms, represent a final stage of surgical treatment of patients with morbid obesity. The indications, technique and the results of plastic operations performed from 1985 to 1998, are thoroughly elucidated. The analysis of early postoperative complications has established, that it a reasonable to perform such operations 1-3 years after gastroplasty when body weight stabilizes and there are no vitamin deficiency, iron deficient anemia, hypoproteinemia, hydroionic disturbances or other complications of the later period. Complex prophylactic measures for prevention of pyoseptic and thromboembolic complications in patients with obesity late after gastroplasty permits to avoid severe complications and lethal outcomes in patients after plastic operations.

[Laparoscopic and standard cholecystectomy: comparison of immediate results]. / Laparoskopicheskaia i traditsionnaia kholetsistéktomia: sravnenie neposredstvennykh rezyl'tatov.

The advantages of laparoscopic cholecystectomy (LChE) are undoubtable in comparison with traditional one. However the experience showed, that LChE is not devoid of some shortcomings. It is characterized by the same typical complications as in ChE, besides it may be followed by some specific complications. The literature concerning the rate of complications in LChE are controversial. The comparative analysis has been carried out concerning the rate of complications after ChE (6800 operations) and LchE (900). The mean age of patients with choledocholythiasis--61.4 years. 40% of the patients had severe accompanying diseases coronary artery disease, complicated forms of arrythmia, arterial hypertension, diabetes mellitus, obesity. There were no significant differences between patients who underwent ChE (group 1) and LChE (group 2) by their age and the rate of accompanying diseases. Intraoperative cholangiography was performed in 3.5% of cases of group 1 and in 1.1%--in group 2. The average rate of the operations on extrahepatic bile ducts in group 1 was also lower--choledocholithotomy was carried out in 2.7%, transduodenal papillosphyncterotomy--in 1.7% of cases, drainage of the choledochal duct--in 1.9%. Combined operations were carried out in 10% of patients of group 1 and in 9.1% cases of group 2. The rate of intraoperative bleedings which demanded repeated operations made up in patients of group 1 0.1%, in patients of group 2 0.5%. Intraoperative damage of the choledochal duct in group 1 were detected in 0.14% and in group 2--in 0.11% of cases (the only complication of LChE in a patient was assessed as a endogenous wall clipping).

[Laparoscopic horizontal gastroplasty]. / Laparoskopicheskaia gorizontal'naia gastroplastika.

The analysis of the first 14 operations of horizontal gastroplasty in patients with end-stage alimentary constitutional obesity was carried out, the operations being performed according to standard (9 patients) as well as laparoscopic method (5 patients). The mean body mass made up 133.6 kg, the mean height being 167.8 cm. Patients age was from 22 to 42 years. All the patients operated by laparoscopic method were women. Technique of laparoscopic horizontal gastroplasty is described, indications and contraindications to the operation are established. It is demonstrated, that laparoscopic gastroplasty, as well as previously performed 530 horizontal gastroplasties with the help of fluoric-lausan goffer band, performed in clinic since 1984, in present time is one of the most perspective method of surgical correction of obesity. The application of this method results in substantial and steady decrease of body mass of the operated patients with minimal risk of complications during surgical procedure as well as in postoperative period.

[Aspirative lipectomy in patients with alimentary-constitutional obesity]. / Aspiratsionnaia lipektomiia u bol'nykh alimentarno-kostitutsionnym ozhireniem.

The results of aspirative lipectomy in patients with 2nd and 3rd stage of alimentary-constitutional obesity are analysed. The effectiveness of lipectomy with surgical creation of a small ventricle and without previous surgery, has been demonstrated. The criteria of patients selection, based on their somatic and psychic features, are formulated. Aspirative lipectomy has certain advantages over other types of plastic surgery as it has the minimal rate of postoperative complications.

[Surgical interventions in patients with a history of alimentary constitutional obesity]. / Khirurgicheskie vmeshchatel'stva u bol'nykh v otdalënnye sroki posle operativnogo lecheniia alimentarno-konstitutsional'nogo ozhireniia.

Surgical removal of a fat "flap" is a last step of surgical treatment of patients with 3-d and 4-th stage of alimentary obesity. This kind of surgery makes sense only 12-24 months after "small stomach" creation. During this period the weight is stable. A detailed clinical examination and prophylaxis helps to avoid septic and thromboembolic complications that may cause death and usually appear short time after the operation. To minimize postoperative complications and to decrease a risk of repeated anaesthesia and time of stay in a hospital it is necessary to make some concomitant small surgical procedure (cholecystectomy, phlebectomy).

[Topical diagnosis of pancreatic insulinomas]. / Topicheskaia diagnostika insulinom podzheludochnoi zhelezy.

Diagnosis of pancreatic insulinomas has been performed. Celiacography appeared to be the most efficient diagnostic method (more than 50% of sensitivity). Intraoperative ultrasound testing, that have been done in 16 patients, managed to make a topical diagnosis with a high accuracy and to evaluate relation of a tumor with portal vessels and pancreatic duct that is very important in choosing a proper surgical technique.

[Long-term results of the treatment with stomach reducing operations in patients with alimentary constitutional obesity]. / Otdalennye rezultaty lecheniia bolnykh s krainimi stepeniami alimentarno-konstitutsionalnogo ozhireniia s pomoshchíu operatsii formirovaniia malogo zheludka.

The authors analyse experience in the treatment of 415 patients with extreme alimentary-constitutional obesity (ACO) by operation for formation of a small stomach (FSS). Seventy-five patients were followed up and examined 3-5 years after the operation. FSS leads to stable and significant loss of body weight. Its degree depends on the diameter of the anastomosis between the proximal and distal parts of the stomach and the initial excess of body weight. The working capacity of the patients is restored in the late-term postoperative periods and diseases attendant to obesity disappear or take a milder course. The success of the treatment is determined significantly by the correct choice of the patients for surgery. Operations for FSS may be repeated for very strict indications in specialized clinics experienced in the treatment of patients with obesity.