LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING. ILLUSIONS AND REALITY.

This work analyzed the results of surgical treatment of 380 patients who underwent the laparoscopic adjustable gastric banding (LAGB) at the period from 2004 to 2015. The patients were initially divided into 2 groups with metabolic syndrome (MS) and without MS according to the sex, age (up to 40 years old or older). As the result of performed analysis, there was stated that LAGB operation wasn't effective and couldn't be recommended for an application on the patients with MS. The patients have to follow necessary advice for life. Otherwise, the probability of complication development and recurrent operation would be really high and because of this, the more effective surgical treatment should be initially used. LAGB operation didn't influence on pathogenetic mechanisms of main components of MS and couldn't be regarded as effective. This LAGB operation is reasonable to apply in women without MS of young age group with initial body mass index lower than 43 kg/m². These women have to be able strictly follow doctor's advice for life.

LAPOROSCOPIC SLEEVE GASTRECTOMY. ROLE AND PLACE IN BARIATRIC SURGERY.

Laparoscopic sleeve gastrectomy (LSG) was performed in 522 patients at the period from 2007 to 2015. The operation was carried out by different methods. It was stated that «the ideal candidates¼ for choosing LSG operation were the patients without metabolic syndrome (MS) and body-weight index, which wasn't higher than 48 kg/m². The operation could be performed on patients younger than 40 years old in order to correct disorders of insulinic and cholesterol metabolism. Patients with MS have limitations for LSG application, because of this reason, the operation is advisable for younger age group without severe accompanying pathology. The operation could be applied in older age group in order to stabilize general condition in case of high risks as the first (sometimes the last) stage of treatment for the patients whom more effective operation couldn't be recommended.

[IMMUNE RESPONSE IN PATIENTS WITH COLORECTAL CANCER IN POSTOPERATIVE PERIOD].

It was shown by the authors that changes of the level of cytokines reflected the degree of invasiveness of operative intervention. The endovideosurgical approach was less traumatic and provided a rapid rehabilitation of the patients in postoperative period. It is possible to consider the high levels of IL-10 as a predictor of development of local inflammatory process and as an indicator of probable infectious complications in postoperative period.

[ASSESSMENT OF EFFICACY OF MELATONIN IN SURGICAL TREATMENT OF COLON TUMORS].

Melatonin is neurohormone, which is involved in regulation of many functions of an organism, including the digestive system. Therefore the authors offered to include this hormone as a preconditioner factor in surgical treatment of colon tumors using laparotomy and laparoscopy. Preoperative application of melatonin allowed shortening the terms of postoperative period and hospital stay.

[Prevention for gastroesophageal reflux disease after gastric restriction interventions].

The article analyzed the results of surgery using tree gastric restriction laparoscopic operations which led to high possibility of the development of gastroesophageal reflux disease (GERD). Laparoscopic stomach length resection was performed in 327 (68.1%) out of 480 (62.1%) patients. Laparoscopic gastric bypass surgery took place in 142 (29.5%) cases and laparoscopic biliary-pancreatic bypass surgery--in 11 (2.3%). The diagnosis of GERD was established in 193 (40.2%) patients before the operation and it was usually accompanied by hernia of the esophageal opening (HEO). The patients were arranged in 4 groups. The first group had operations using the standard method and it included 287 (59.8%) patients without any signs of GERD or HEO. The patients of the second group (84 (17.5%) had signs of GERD and HEO and standard operations with a hernia removal and cruroraphy were carried out. The patients of the third group 109 (22.7%) had initial signs of GERD and the standard method was used for them. The developed method was applied for patients of the fourth group (132 (27.5%). All the operations were completed by antireflux valve formation, but in the cases of GERD and HEO presence, they accomplished by hernia removal, cruroraphy. After performing standard operations, the signs of GERD were noted in 51.5% of cases. Thus, patients of the first group (148 (51.5%) had the signs of GERD. It was noted, that the signs of GERD were presented in patients of the second group (79 (94%) and it numbered 97 (89%) patients of the third group. In the case of the fourth group, signs of GERD were in 14 (10.6%) patients.

[Surgical correction of dislipodemia in patients with obesity].

The results of surgical treatment of 139 patients with metabolic syndrome, obesity and dislipodemia were analyzed. Modern bariatric operations (4 types) were performed by using laparoscopic method. There were regulated bandages of the stomach (RBS), lengthwise gastric resections (LGR), biliopancreatic and stomach bypass surgeries (BBS, SBS). Results of five-year follow-up indicated that restrictive operations on the stomach (RBS, LGR) aimed to correct overweight and dislipodemia had some limitations to application in a varying degree. The RBS operation should be appropriate to use for women of the young age group, when an initial body-weight index wasn't more than 43 kg/m2. The LGR operation was effective for men of the young age group and women in case of moderately expressed dislipodemia and in case when the initial body-weight index didn't exceed more than 45 kg/m2. Combined bariatric operations (BBS, SBS) were most likely effective on body weight and dislipodemia.

[Metabolic surgery in treatment of diabetes mellitus of type II].

Nowadays, according to data of WHO, the diabetes mellitus was diagnosed in more than 280 million people. The diabetes mellitus type II had 90% patients. The applied methods of conservative therapy seldom lead to euglycemia condition of patients. Last years the treatment of diabetes mellitus was carried out by the method of different bariatic interventions. Good results was obtained, they should be analyzed and investigate. The results of treatment of 142 patients from 628 patients (with type II) were estimated. The patients were undergone by different bariatic interventions. Modern laparoscopic operations were performed on all the patients. Controlled bandage of stomach had 81 of patients. Gastric resection was performed in 28. Gastric bypass surgery was carried out in 22 of patients and biliopancreatic diversion - in 11. The improvement of control of leukemia level was obtained. Diabetes type II could be treated by surgical methods. The best results were obtained after combined operations, which potentially could present an alternative method of treatment of type II diabetes.

[Surgical correction of damage in complex treatment of patients with metabolic syndrome].

The authors have analyzed results of treatment of 407 patients subjected to different bariatric interventions. In 359 out of them there were different bariatric operations, in 48 patients intragastric balloons were placed. Correcting plastic operations were fulfilled in 36 patients within 1-2 years after bariatric intervention. It was found that bariatric intervention fulfilled in earlier age groups would prevent the development of metabolic syndrome (MS) in patients with obesity at later date. Combined operations are most effective bariatric intervention compared with all main elements of MS. Correcting plastic operations are expedient after bariatric interventions against the background of stabilized decrease of body mass that allows getting valuable therapeutic and esthetic effect, improvement of quality of life of patients.

[Sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetes mellitus patients with obesity].

AIM: To investigate sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetics with obesity. MATERIAL AND METHODS: Sex- and age-specific features of hypertension prevalence were studied in 6177 (1345 males and 4832 females) type 2 diabetic obese citizens of the Novgorod region. RESULTS: The highest incidence of mild hypertension was found in obesity degrees I and II (50-68%). Prevalence of moderate and severe hypertension reached 20-31 and 4-5%, respectively, in obesity of degree I and II, 15% in males and 11% in females in obesity degree III. CONCLUSION: In type 2 DM obese patients mild hypertension occurs most frequently. Severe hypertension develops often in males with obesity degree II and III in age groups 50-59 and 60-69 years, in females--in any obesity at the age of 70 and older.

[Complications after the operation of laparoscopic adjustable gastric banding in treatment of patients with obesity].

Operations of laparoscopic adjustable gastric banding (LAGB) have been fulfilled on 2958 patients for treatment of different forms of obesity. The age of the patients was 38 +/- 7.5 years (from 16 to 60 years). There were 80% of women (2366) and 20% of men (592). Mean preoperative body mass index was from 35 to 54 kg/m2, i.e 43 +/- 3.8 kg/m2, fluctuating from 35 kg/m2 to 54 kg/m2. Bands of the following firms were used: Lap Band, Inamed, (USA), AMI Soft Band, Austria, Swedish Band J & J, USA. A description of complications in the early and late postoperative periods are given, associated with the dilatation of the formed "miniature ventricles, occlusion of intercommunication between the miniature ventricle and large ventricle with disturbed evacuation of the content, erosion of the gastric mucosa in the area of the band without its penetration, slippage of the band, complications associated with the regulation system etc. Recommendations were worked out for decreasing the number of complications. The data obtained suggest that LAGB is a highly effective method giving good results of treatment of patients with obesity and coexisting diseases. Most of the appearing complications can be eliminated laparoscopically.

[Laparoscopic adjustable gastric banding in treatment of patients with obesity].

Laparoscopic adjustable gastric banding (LAGB) has been fulfilled in 2958 patients in the period since 1998 through 2006 for treatment of different forms of obesity. The age of the patients was from 16 to 60 years (mean age 38 years). There were 80% of women (2366) and 20% of men (592). Mean preoperative body mass index was from 35 to 54 kg/m2, i.e 43+/-3.8 kg/m2, fluctuating from 35 kg/m2 to 54 kg/m2. The observation of 2485 (84%) patients operated in the terms in question showed the influence of LAGB on metabolic derangement, arterial pressure. Statistical data on possible early and late postoperative complications are presented. The operation of LAGB is one of minimally invasive methods for adjustable decreasing the excess body weight and its effectiveness exceeds other methods of restrictive interventions on the stomach, has a number of advantages compared with other bariatric interventions, it is relatively safe and completely reversible bariatric operation with all advantages of minimally invasive techniques.

[Use of gastric balloon in treatment of patients with obesity].

Gastric ballons (GB) were introduced in 37 patients (34 women and 3 men) aged from 18 through 57 years (mean age 35.2 years) for treatment of different forms of excess body weight and obesity. Mean index of the body mass at the moment of introducing the balloon was 102.3+/-8 kg varying within the range of 80 to 178 kg. The body mass index was on the average 37.9 kg/m2 (29-63). Possible complications and clinical manifestations after introduction of GB are considered. An analysis of the results of treatment and of the nearest and long-term results shows that the body mass became on the average 78.9+/-5 kg (62-138), the body mass index decreased on the average to 29+/-1.6 kg/m2 (22-46). Maximum body weight loss was 48 kg. Using the gastric balloon is considered to be a minimally invasive technique directed to decreasing the excess body mass and its effectiveness to be higher than other methods of conservative therapy. The application of GB substantially extends the chances to help patients with obesity with the minimal risk for health and life.