The role of laparoscopic modified antireflux monoanastomotic gastric bypass in the treatment of morbid obesity

IF 0.1 Q4 MEDICINE, GENERAL & INTERNAL
A. Klymenko, M. Nikolaiev
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引用次数: 0

Abstract

Aim. Improving the results of surgical treatment for patients with morbid obesity by evaluating the effectiveness and comparing the results of bariatric operations, namely laparoscopic modified monoanastomotic gastric bypass (LMMGB) and laparoscopic standard Roux-en-Y.Materials and methods. The work analyzed the results of treatment of 41 patients with morbid obesity. All patients were divided into two groups. LMMGB surgery was performed for 30 patients (the main group). The control group consisted of 11 patients after the standard technique of laparoscopic standard Roux-en-Y. Inclusion criteria were: persons of both sexes aged 18–60 years with morbid obesity and body mass index of 40 kg/m2 or more, as well as 35 kg/m2 or more in the presence of comorbid diseases (type 2 diabetes, hypertension, dyslipidemia, sleep apnea syndrome). Body weight of the patients ranged from 83 kg to 173 kg. The average body mass index was 42.5 kg/m2 in the main group before the operation. Violation of carbohydrate metabolism, which is included in the criteria of metabolic syndrome, was detected in 28 (93.33 %) of 30 studied patients of the main group and in 10 (90.90 %) of 11 studied patients of the control group. Comorbid pathology was found in 76.67 % of the main group and 72.72 % of the control group.Statistical processing was carried out via the Statistica 13.0 software package using parametric and non-parametric statistical methods.Results. There were no deaths, anastomosis failures, conversions, and intraoperative complications. The duration of LMMGB operation ranged from 120 to 290 minutes. The postoperative period was 5 days in the main group and 7 days in the control group, that is, a statistically significant reduction in the postoperative period duration was observed. In both groups, a decrease in body weight ranged from 12 kg to 81 kg within 6 months. In the main group, the median weight loss was 26.0 kg after 6 months and 38.5 kg after 12 months. BMI was 31.25 kg/m2 after 6 months, 26.88 kg/m2 after 12 months. In the control group, this indicator was 28.0 kg after 6 months and 42.0 kg after 12 months. Median BMI after 6 months – 31.64 kg/m2, after 12 months – 26.03 kg/m2, respectively. After the operation, there was a tendency towards an increase in all indicators of quality of life, both in the group of patients who underwent gastric bypass according to the classic Roux technique and in the group of patients after LMMGB. Clinical manifestations of the enterogastric biliary reflex were detected in both groups, in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. No statistically significant difference was found in these parameters.Conclusions. Monoanastomotic gastric bypass in the modification of the clinic has the same positive properties as the standard Roux-en-Y technique, allowing to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone a mini-gastric bypass surgery need a thorough examination with fibrogastroscopy in combination with pH-impedance measurement at least once a year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stump of the stomach. The quality of life level does not significantly differ after surgery between patients of the control group and the main group based on the results of the GERG-Questionnaire indicating the effectiveness of the laparoscopic monoanastomotic gastric bypass technique modified in the clinic.
腹腔镜改良抗反流单吻合胃旁路术治疗病态肥胖的作用
的目标。通过评价腹腔镜改良单吻合胃旁路术(LMMGB)与腹腔镜标准Roux-en-Y减肥手术的效果及效果比较,提高病态肥胖患者的手术治疗效果。材料和方法。对41例病态肥胖患者的治疗结果进行了分析。所有患者分为两组。30例患者行LMMGB手术(主组)。对照组11例患者采用腹腔镜标准Roux-en-Y技术。纳入标准为:年龄在18-60岁的男性和女性,病态肥胖,体重指数在40 kg/m2以上,以及存在合并症(2型糖尿病、高血压、血脂异常、睡眠呼吸暂停综合征)的35 kg/m2以上。患者体重为83 ~ 173公斤。主组术前平均体重指数为42.5 kg/m2。主要组30例患者中有28例(93.33%)存在代谢综合征标准中的碳水化合物代谢异常,对照组11例患者中有10例(90.90%)存在碳水化合物代谢异常。主组和对照组共病病理发生率分别为76.67%和72.72%。采用参数统计和非参数统计方法,通过Statistica 13.0软件包进行统计处理。无死亡、吻合失败、转换和术中并发症。LMMGB的操作时间为120 ~ 290分钟。主组术后时间为5天,对照组为7天,即术后时间缩短有统计学意义。在6个月内,两组的体重下降幅度从12公斤到81公斤不等。在主组中,6个月后中位体重减轻26.0 kg, 12个月后中位体重减轻38.5 kg。6个月BMI为31.25 kg/m2, 12个月BMI为26.88 kg/m2。对照组6个月后该指标为28.0 kg, 12个月后为42.0 kg。6个月后中位BMI为31.64 kg/m2, 12个月后中位BMI为26.03 kg/m2。手术后,无论是采用经典Roux技术行胃分流术的患者组,还是LMMGB术后患者,其生活质量的各项指标均有提高的趋势。检测两组患者肠胃胆反射的临床表现,并记录两组患者相应症状的临床表现。这些参数均无统计学差异。单吻合胃旁路术在临床改良中具有与标准Roux-en-Y技术相同的积极特性,可以避免可能的胆汁病理反流进入食管的相关风险。接受小型胃旁路手术的患者需要每年至少进行一次纤维胃镜检查,并结合ph阻抗测量,以确定食道管腔和胃残端胆道反流和形态学变化。根据GERG-Questionnaire的结果,对照组和主组患者术后生活质量水平无明显差异,表明经改良的腹腔镜单吻合器胃旁道技术在临床上的有效性。
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来源期刊
Zaporozhye Medical Journal
Zaporozhye Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
0.00%
发文量
72
审稿时长
8 weeks
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