[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).

[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.

[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.

[Late results of the treatment of patients with the extreme degree of alimentary-constitutional obesity by the method of formation of a small stomach]. / Otdalennye rezul'taty lecheniia bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia metodom formirovaniia malogo zheludka.

The work analyses the results of treatment of 311 patients with extreme degrees of alimentary-constitutional obesity by formation of a small stomach. Fatal outcomes (1.9%) were encountered in the period of operative technique mastering. The late-term results were studied in 167 patients in follow-up periods of up to 3 years. The patients' average body weight was 149.4 kg, average height 166.2 cm, average body weight excess as compared to the ideal weight was 125.6%. Study of the late-term results of the operation showed that the postoperative weight loss depends on the initial weight excess and the diameter of the anastomosis formed between the proximal and distal parts of the stomach. The more the initial excess of weight as compared to the ideal value, the more the loss of body weight is. The diameter of the formed anastomosis should be no larger than 15 mm. Besides loss of weight, the activity of vital organs and systems is normalized after the operation, and arterial hypertension, diabetes mellitus, the Pickwickian syndrome, and metabolic polyarthritis take a milder course. The operation for formation of a small stomach made it possible for the patients to resume their customary occupation, freed them of the threat of invalidation, and reduced the duration of the disability period by 4.3 times. After surgical treatment the nature of the patients' life significantly improved; 95.8% of patients appraised the effect of the treatment as excellent and good.

[Changes in the degree of oxygenation of gastric mucosa before and after the operation of creating a small stomach in patients with the extreme degree of alimentary-constitutional obesity]. / Izmeneniia urovnei oksigenatsii slizistoi obolochki zheludka do i posle operatsii formirovaniia malogo zheludka u bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia.

The authors examined 131 patients with alimentary-constitutional obesity of Degrees III-IV before and after operation for "small stomach" formation. All patients underwent pre- and post-operative endoscopy of the esophagus, stomach and duodenum. The level of gastric mucosa oxygenation was measured in 50 patients before and in various periods after surgery. For this purpose the authors suggested an original endoscopic +spectrum analyzer and a method for determining the level of oxygenation of the mucosa of the organ. The level of gastric mucosa oxygenation was significantly lower in patients with obesity than in healthy individuals of the control group. After the operation the oxygenation level increased significantly, which was connected with an altered diet regimen, reduced amount of the ingested food, loss of weight, and improved microcirculation in the mucous membrane of the organs of the alimentary tract. The authors emphasize in particular the absence of blood supply disorders at the site of application of a synthetic fluoronlavsan band (in the region of the anastomosis), which is among the indices of the physiological property of this method for surgical treatment of patients with alimentary-constitutional obesity.

[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.

[Status of the protective gastric mucosal barrier in patients with alimentary-constitutional obesity before and after creating a "small stomach"]. / Sostoianie zashchitnogo bar'era zheludka u bol'nykh alimentarno- konstitutsional'nym ozhireniem do i posle formirovaniia "malogo zheludoczka".

The authors examined 131 patients with degree III-IV alimentary-constitutional obesity before and after operation for formation of a "small stomach". The average body weight of the patients before surgery was 145 +/- 2.28 kg. In the first 12 postoperative months it reduced by 41.9 +/- 1.76 kg as compared to the initial weight. Diminution of body weight in the second year was statistically insignificant. All patients underwent endoscopy of the esophagus and stomach before and after the operation with appraisal of the degree of macroscopic changes of the mucous membrane. The incidence of chronic gastritis and esophagitis reduced in the postoperative late-term periods more than 1.5 times, that of erosive lesions more than 10 times. Targent measurement of the transmural potential difference (TPD) of the esophagus and stomach was conducted in 36 patients. The TPD value is much less in patients with obesity than in the control group of healthy individuals. After operation the TPD value grows significantly which is due to changes of the diet regimen, reduced amount of the ingested food, reduction of body weight, and improved processes of microcirculation in the mucous membrane of the gastrointestinal tract.

[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.

[Hematologic indicators in patients with morbid obesity after surgical creation of the miniature stomach]. / Gematologicheskie pokazateli u bo'lnykh s krainei stepe'niu alimentarno-konstitutsiona'lnogo ozhireniia posle operatsii formirovaniia malogo zheludka.

Surgical establishment of miniature stomach was conducted in 28 patients with severe alimentary-constitutional obesity (mean body weight 155.7 kg). After a 18-36-month follow-up the patients underwent hematological examination. It was found that a 134% excess of body weight registered preoperatively dropped to 54%. Reduced levels of blood red cells, hemoglobin, serum iron were not registered. Neither was anemia. This shows that physiological function of the whole gastrointestinal tract was not damaged, the blood loss appeared insignificant. Substitution therapy with hemostimulants during the following two years may be avoided.