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EVALUATION OF THE RESULTS OF A MODIFIED METHOD OF MINI-
GASTRIC BYPASS IN OBESITY AGAINST THE BACKGROUND OF
TYPE 2 DIABETES MELLITUS
Sotiboldiev A.A.
Botirov J.A.
Ibragimov U.Ya.
Andijan State Medical Institute, Uzbekistan
https://doi.org/10.5281/zenodo.13893009
Relevance of the problem.
There are more than 40 different types of
bariatric surgeries, conventionally divided into 3 groups [2], which indicates the
lack of a unified approach to solving this pathology, which dictates the need for
further analysis [1]. Gastric bypass (GB) has a restrictive-malabsorptive
mechanism of action, is performed either as a Roux-en-Y gastric bypass or as a
mini-gastric bypass and allows for a 60-70% reduction in div mass index
(BMI), which many specialists consider the "gold standard" of bariatric surgery
[2; 4].
However, the use of GB with one anastomosis leads to the development of
bile reflux as a manifestation of afferent loop syndrome (ALS), the appearance of
an ulcer in the anastomosis zone (up to 16%) with subsequent development of
bleeding, perforations, malignancy or stenosis of the gastroenteroanastomosis
(up to 20%), which in 25% of cases requires repeated surgical intervention [3;
4].
Therefore, the search for ways to solve the problem of obesity in the
background of type 2 DM is justified, since it is aimed at improving the results of
surgical treatment of obesity in the background of type 2 DM, which was the
subject of this study.
The aim of the research
is to improve the results of surgical treatment for
obesity associated with diabetes mellitus (DM-2), development and clinical
application of a modified method of laparoscopic mini-gastroshunting surgery.
Material and methods of the research.
The work is based on the results
of a retrospective and prospective analysis of patients with obesity against the
background of type 2 diabetes mellitus (hereinafter referred to as type 2 DM) for
the period 2023 to 2024 subject to surgical treatment in the private clinic
"Sekhat" in Andijan and in the third surgical department of the Clinic of the
Andijan State Medical Institute. The subject of this study were 177 patients with
obesity against the background of type 2 DM. According to the purpose and
objectives, the patients under study were conditionally divided into two groups:
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-
comparison group
- (2023) - 49 (27.7%) patients who underwent a
retrospective analysis of the results of surgical treatment in compliance with
traditional approaches;
-
main group
- (2024) - 128 (72.3%) patients who underwent a
prospective study of the results of surgical treatment using optimized surgical
tactics.
The standard of examination of the studied patients before bariatric
intervention consisted of an assessment of physical parameters with the
implementation of laboratory, instrumental and statistical research methods in
accordance with the latest clinical guidelines (Dedov I.I. et al., 2018 and
protocols approved by the Ministry of Health of the Republic of Uzbekistan.
Results and discussion.
All postoperative complications are conditionally
divided into:
1)
complications directly related to the bariatric surgery (specific
complications) - anastomotic suture failure, afferent loop syndrome,
hypoglycemic syndrome, diarrhea, gastroesophageal reflux;
2)
wound - infiltrate, suppuration of the postoperative wound, ligature
fistula;
3)
complications not related to the bariatric surgery, which may also occur in
other surgeries (general complications).
In the main group, after laparoscopic mini-gastroshunting surgery
performed by a modified method, complications associated with bariatric
surgery were diagnosed in 6 patients (4.7%). Of these, with the first degree of
obesity against the background of type 2 DM - in 2 cases (1.6%), with the second
- in 3 cases (2.3%) and with the third - in 1 case (0.8%).
In the main group, after laparoscopic mini-gastroshunting surgery
performed by a modified method, wound complications (purulent-septic) were
diagnosed in 7 patients (5.5%). Of these, with the first degree of obesity against
the background of type 2 DM - in 3 cases (2.3%), with the second - in 2 cases
(1.6%) and with the third - in 2 cases (1.6%).
In the main group, after laparoscopic mini-gastroshunt surgery performed
using a modified method, general complications were diagnosed in 5 (3.9%)
patients. Of these, with the first degree of obesity against the background of type
2 DM - in 3 (2.3%) cases, with the second - in 1 (0.8%) and with the third - in 1
(0.8%), with a fatal outcome in 1 (0.8%) case.
Summary.
The conducted analysis of the results of laparoscopic mini-
gastroshunting surgery shows that this contingent of patients has recently
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begun to receive highly qualified specialized care in our country for the first
time. In addition, bariatric surgeries require a multidisciplinary approach and in
the vast majority of cases (94.5%) contribute to the recovery of patients from
this suffering (complications associated with bariatric surgery - 6 (4.7%) and
general, with a fatal outcome in 1 (0.8%)).
Our first experience has shown that the method of laparoscopic mini-
gastroshunting surgery proposed by us in a modified way allows us to achieve
good results for the doctor and the patient, including the prevention of afferent
loop syndrome.
References:
1.
Balandov S.G., Vasilevsky D.I., Anisimova K.A., et al. Principles of choosing
bariatric interventions (literature review). Scientific notes of St. Petersburg State
Medical University. 2020; 27 (4): 38-45.
2.
Dedov I.I., Melnichenko G.A., Shestakova M.V., et al. National clinical
guidelines for the treatment of morbid obesity in adults. 3rd revision
(Treatment of morbid obesity in adults). Obesity and metabolism. - 2018. - V. 15.
- P. 53-70.
3.
Yashkov Yu.I., Sedletsky Yu.I., Vasilevsky D.I., et al. Principles of choosing
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I.I. Grekov. - 2020. - T. 179, No. 1. - P. 95-104.
4.
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Why Biliary Refl ux Remains Controversial? Obes Surg. 2017;27(2):545-547.
5.
Bruzzi M., Rau C., Voron T. Et al. Single anastomosis or mini-gastric bypass:
long-term results and quality of life after a 5-year followup. Surg Obes Relat Dis.
2015; 11:321-326.
