EFFECTS OF BODY WEIGHT REDUCTION ON ARTERIAL STIFFNESS AND ENDOTHELIAL FUNCTION AFTER BARIATRIC SURGERY IN MORBIDLY OBESE PATIENTS: A 4-YEAR CLINICAL STUDY.

OBJECTIVE: To determine the long-term effect of weight loss on arterial stiffness, metabolic parameters in morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB). SUBJECTS: Forty-eight morbidly obese Caucasian subjects underwent LAGB from January 2009 to January 2010 and completed 4 years follow-up. MEASUREMENTS: Patients were evaluated for body mass index (BMI), waist circumference, arterial blood pressure (BP), metabolic factors: leptin, adiponectin, glucose, glycated haemoglobin (HbA1c), insulin. Endothelial function - evaluated as reactive hyperemic index (RHI). Arterial stiffness - determined by cardio - ankle vascular index (CAVI). RESULTS: Average BMI decreased from 46.48±7.06 kg/m2 to 39.78±7.36 kg/m2 (1year, p<0.001) and 37.29±7.49 kg/m2 (4years, p=0.012). The systolic BP and heart rate reduction were observed after the 4 years. Changes in cardiovascular parameters were accompanied by waist circumference reduction and improvement of glucose metabolism,reduction of insulin, HbA1c, leptin, C-reactive protein values. However, there were statistically significant increases in CAVI 6.58±1.77m/s vs. 7.03±2.00 m/s (p=0.014) at 1 year, but not significant 7.12±2.19 (p=0.153) after 4 years. Endothelial changes were observed only in diabetic patients one year after LAGB 2.18±0.57 vs. 1.86±0.34 (p=0.021) vs. 2.05±0.42 (p=0.086). CONCLUSION: Weight reduction induced by LAGB was associated with changes in body weight and metabolic parameters, but it was no improvement on endothelial function and arterial stiffness.

[State of the liver in patients with obesity at distant periods after formation of a "small stomach"]. / Sostoianie pecheni u bol'nykh ozhireniem v otdalennye sroki posle operatsii formirovaniia "malogo zheludka".

Histological study of biopsy specimens taken from the liver of 96 patients during operation for formation of a "small stomach" revealed fatty dystrophy of the liver in 93 patients (96.9%) which was attended by marked inflammatory and fibrous changes in 68 (70.8%) of them and by disturbed lobar structure of the liver (cirrhosis) in 2 patients (2.1%). Biochemical blood tests failed to show the pattern of the pathological changes before the operation. Study of the hepatobiliary system with methionine-75Se was the only method by which protein and pigment metabolism in the liver could be appraised. Examination of patients during 3 postoperative years showed a positive dynamics of changes in biochemical blood tests and improved protein metabolism in the hepatocytes according to the results of scanning of the liver with methionine-75Se. Thirteen repeated studies of the hepatic tissue collected from patients in different periods after operation for the formation of a "small stomach" showed a significant diminution of fatty dystrophy and inflammation of the parenchyma. The level of portal tract inflammation and portal fibrosis did not change. The findings suggest that there is an improved functional and morphological condition of the liver in weight loss caused by operation for the formation of a "small stomach", which allows this type of surgical intervention to be recommended for the treatment of patients with alimentary-constitutional obesity and initially diminished compensatory capacities of the liver.

[Results of surgical formation of small stomach in patients with morbid obesity]. / Rezul'taty operatsii formirovaniia malogo zheludochka u bol'nykh so sverkhozhireniem.

The authors conducted a comparative analysis of the results of surgical treatment of patients with alimentary-constitutional adiposity (ACA) of extreme degrees. Operation for the formation of a small stomach (SSF) was carried out in 41 patients. The results in the same patients were analysed in postoperative periods of more than 2 years. The patients were divided into 2 groups. The first group was composed of 22 patients with morbid obesity and an average body weight of 140.2 +/- 4.47 kg (101.4 +/- 3.83% excess weight). The second group was made up of 19 patients with an average body weight of 170.2 +/- 6.5 kg (average excess weight 169.8 +/- 7.03%). The average weight loss in the first group was 41.9 kg (59.9% loss of excessive weight), the average weight loss in patients with hyperadiposis (second group) was 62.9 kg (99.4% loss of excessive weight). The results of operation for SSF for reducing body weight in patients with adiposity are better than those of vertical gastroplasty.

[Results of the operation for creating "miniature stomach" in the treatment of alimentary-constitutional obesity]. / Rezul'taty operatsii formirovaniia "malogo zheludochka" v lechenii alimentarno-konstitutsional'nogo ozhireniia.

The article analyses the results of surgical treatment of alimentary-constitutional obesity in 207 patients by means of operation for formation of a "miniature stomach". Total postoperative mortality was 2.4%. This index was 4.2% in the period when the method was mastered and 0.89% for the next 112 operations. It is shown that the operation for formation of a "miniature stomach" leads to a significant and stable loss of body weight, recovery from concomitant diseases or essential diminution of their severity, it alters the patients' life for the better and makes it possible for many of them to resume work.