COMPARATIVE ANALYSIS OF EFFECTS INDUCED BY STANDARD AND MODIFIED LAPAROSCOPIC SLEEVE GASTRECTOMY PERFORMANCE ON SHORT TERM AND DISTAL COMPLICATIONS IN PATIENTS WITH 3RD DEGREE OF MORBID OBESITY.

Introduction: The effective techniques of surgical intervention that ensure the desired level of weight reduction outcomes (decreased level of obesity) not always improve QOL outcomes, explained by a range of post-surgery complications. There are the specific complications, strongly impacting the QOL of the patients after bariatric surgery and increasing postoperative comorbidity.

Aim: The aim of this retrospective case control study was to evaluate the relative safety of primary LSG performed with standard and modified LSG techniques according to the Clavien-Dindo complication grading system and the rate of long-term complications in patients with BMI>40.

Materials and methods: A total of 497 cases of patients were divided into 2 groups in accordance with the type of LSG performed. The first group (n = 246) were the patients managed with the Standard protocol of LSG and the second group (n = 251) included the patients treated with the modified protocol of the LSG. The prevalence of specific post-bariatric complications and short-term (30-days) complications was calculated and compared in the groups. The long-term complications were assessed after 1-year օf post-operation period in both intervention groups. The relative risk ratio, p-value and CI95% were calculated for all complications. The short-term (30-days) complications assessment in both intervention groups was performed in accordance with Clavien-Dindo classification of surgical complications.

Results: The remarkable reduction of relative risks was registered for the minor and major complications rates. Similarly, the total rates for the minor and major complications demonstrated strong difference between group I and group II (p<0,05). Тhe intraoperative and early (first 72 hours) complications (acute bleeding, and leakage) rates in patients of group I were reliably lower compared to the patients of group II (p<0,05). The RR indicators were 0.123 and 0.121 respectively for acute bleeding and leakage. The indicator of acute obstruction was not essentially different while intergroup comparison was significantly divergent (p<.05). However, the RRR was calculated as 80%. The total rate of intraoperative and first 72 hours complications was 7.3% vs 1.2% in group II. The difference was reliable (p-value<.05) in Gall stone disease, GERD, thrombosis malnutrition and anemia. Comparison of the Renal lithiasis and depression didn't reveal any essential difference between clinical groups (p-value>.05).

Conclusion: The results we received are direct confirmation of the comparatively higher effectiveness of the modified LSG evidenced by a significant reduction of the major and minor complications in patients with BMI>40.