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IMMEDIATE RESULTS OF MINI-GASTRIC BYPASS IN THE
TRADITIONAL WAY FOR OBESITY AGAINST THE BACKGROUND
OF TYPE 2 DIABETES MELLITUS
Botirov J.A.
Sotiboldiev A.A.
Ibragimov U.Ya.
Andijan State Medical Institute, Uzbekistan
https://doi.org/10.5281/zenodo.13892998
Relevance of the problem.
Obesity is currently becoming a global health
problem worldwide, as about 1.7 billion people are overweight [5;6]. According
to WHO, about 7% of the world's adult population is obese, while in developed
countries about a third of the population (33.3%) is overweight [1]. A direct
relationship has been established between the increase in the prevalence of
obesity and the growth in cases of type 2 diabetes. According to WHO, the
likelihood of developing diabetes increases by 20% with an increase in BMI for
every 1 kg/m
2
[2;3].
In most patients with obesity against the background of type 2 DM, mini-
gastrosurgery allows not only to reduce div weight, but also to normalize
carbohydrate metabolism starting from the early postoperative period [4].
However, the course of the early postoperative period (in the first 30 days after
mini-gastrosurgery) is often overshadowed by the development of
postoperative complications, including "adductor loop syndrome". Therefore,
the search for ways to solve the problem of obesity against the background of
type 2 DM is justified, because it is aimed at improving the results of surgical
treatment of obesity against the background of type 2 DM, which was the subject
of this study.
The aim of the study
is to improve the results of surgical treatment for
obesity associated with diabetes mellitus (DM-2) using laparoscopic mini-gastric
bypass surgery.
Material and methods of the study. The work is based on the results of a
retrospective and prospective analysis of patients with obesity associated with
type 2 diabetes mellitus (hereinafter referred to as DM-2) 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.
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The subject of this study was 177 patients with obesity associated with type
2 diabetes. According to the purpose and objectives, the patients under study
were conditionally divided into two groups:
- 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 comparison group, after laparoscopic mini-gastroshunting surgery
performed by the traditional method, complications associated with bariatric
surgery were noted in 9 (18.4%) patients. Of these, with the first degree of
obesity against the background of type 2 DM - in 4 (8.2%) cases, with the second
- in 3 (6.1%) and with the third - in 2 (4.1%) cases.
In the comparison group, after laparoscopic mini-gastroshunting surgery
performed by the traditional method, wound complications (purulent-septic)
were noted in 6 (12.2%) patients. Of these, with the first degree of obesity
against the background of type 2 DM - in 1 (2.0%) cases, with the second - in 2
(4.1%) and with the third - in 3 (6.1%) cases.
In the comparison group, after laparoscopic mini-gastroshunting surgery
performed in the traditional way, general complications were noted in 5
(10.2%) patients. Of these, with the first degree of obesity against the
background of type 2 DM - in 1 (2.0%) cases, with the second - in 2 (4.1%) and
with the third - in 2 (4.1%), with a fatal outcome in 1 (2.0%) case.
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Summary
. The analysis conducted in the comparison group showed that
after performing laparoscopic mini-gastroshunting surgery in the traditional
way, out of 9 (18.4%) complications directly related to the bariatric surgery, in 7
(14.3%) cases the cause was the development of afferent loop syndrome. This
circumstance prompted us to conduct a detailed analysis and develop a
preventive measure.
References:
1.
Galimov O.V., Khanov V.O., Sagitdinov R.R. Surgical treatment of
cholecystitis in patients suffering from obesity / O.V. Galimov, // Surgeon. -
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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
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- P. 53-70.
3.
Kornyushin O.V., Toropova Ya.G., Neimark A.E. et al. Mechanisms of
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Experimental and Clinical Gastroenterology. 2017. 146 (10): 61-73.
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Fried M. Et al. Interdisciplinary European guidelines on metabolic and
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