Лечение метаболического синдрома методом бесстеплерного одноанастомозного гастрошунтирования: рандомизированное клиническое исследование в сравнении со степлерной технологией

Abstract

BACKGROUND: The authors have developed an original method of laparoscopic gastric bypass significantly reducing financial costs when conducting this surgical treatment of obesity. In the presented article for the first time describes the evaluation of the effectiveness of the proposed to introduce a new type of staplerless gastric bypass compared to the standard stapler method. AIMS: to evaluate the effectiveness of the author’s method of laparoscopic gastric bypass for the treatment of metabolic syndrome with obesity. MATERIALS AND METHODS: This prospective, randomized controlled trial presents the results of surgical treatment of 80 patients with metabolic syndrome. Patients were randomized into two groups of 40 people. In the first group, the author’s method of laparoscopic mini-gastric bypass with a band-separated pouch was implemented, and in the second group, the standard laparoscopic mini-gastric bypass with a standard (stapler-separated) gastric pouch was used. Procedures were performed in the period from 2015 to 2016 with an average follow up period of 3 years. The postoperative change of weight loss and the changes of the main manifestations of the metabolic syndrome, as well as the change in the cardiovascular risk index in the comparison groups were assessed. RESULTS: In both groups there were no significant differences by sex and age. In the first group there were 39 women and 1 man, and in the second group 36 women and 4 men aged 36.75±8.6 years and 40.47±11.0 years, respectively (p=0.097). Three years after surgery, all 80 patients were examined using analysis of variance. At the same time, it was revealed that the change in body mass index after operations, which was 14.02±5.05 kg/m 2 in the first group, and 12.38±5.7 kg/m 2 (p=0.170) in the second group, was found equally good bariatric effect of two compared methods of gastric bypass. The main indicators of blood pressure, as well as laboratory data reflecting the state of carbohydrate and fat metabolism, statistically significantly decreased in both groups to normal values, which suggests a pronounced metabolic effect of both gastric bypass methods. It was established that cardiovascular risk in the first group decreased from 5.4±0.9 to 2.9±0.4 (p<0.001), and in the second group from 5.1±1.1 to 3.1±0.32 (p<0.001). CONCLUSIONS: The results of the use of various types of laparoscopic gastric bypass in the surgical treatment of metabolic syndrome after three years indicate a significant reduction in body weight, normalization of carbohydrate and fat metabolism. In a comparative aspect, the author’s and standard gastric bypass techniques equally positively affect the elimination of the main manifestations of the metabolic syndrome, but the proposed author’s method has insignificant advantages in terms of weight loss.