THE WAY TO PREDICT THE EFFECTIVENESS OF BARIATRIC SURGERY IN PATIENTS WITH COMORBID OBESITY IN POST-PANDEMIC PERIOD

Abstract

Summary. It is estimated that from 650 million to 2 billion adults worldwide, are overweight or obese, the numbers indicating epidemic levels of disease. In individuals, body mass index (BMI) exceeding 27 kg/m2 is associated with a high risk of mortality and the presence of comorbid pathologies, in particular, atherogenic dyslipidemia, arterial hypertension (AH), type 2 diabetes mellitus (T2D), thromboembolism, hepatic steatosis, etc. Preliminary data indicate that obesity is among key risk factors in severe and fatal cases of COVID-19, when comorbid with AH and T2D.
 The aim of this study – to analyze the possibility of developing an optimized model utilizing anamnestic, clinical, biochemical and genetic parameters for predicting the outcomes of bariatric surgery in the patients with obesity, type 2 diabetes mellitus (T2D) and/or arterial hypertension (AH).
 Results. Lifestyle changes and conservative treatment of obesity usually only result in a short-term effect, since the measures aiming to induce weight loss consign the person to a constant struggle with natural homeostatic processes. Recurrence of obesity in such patients is observed in 95 % of the cases. Therefore, the International Association of Endocrinologists recommends that patients with a BMI greater than 40 kg/m2, as well as with a BMI of 35.0 to 39.9 kg/m2 and metabolic syndrome undergo a surgical treatment of obesity using minimally invasive techniques. At the same time, a number of issues associated with bariatric laparoscopic interventions remain unresolved, since these procedures are invasive and carry all the risks accompanying surgery, general anesthesia, and the postoperative recovery period. An innovative surgical approach, the X-ray endovascular bariatric embolization of the gastric arteries (BAE) is proposed as an alternative to laparoscopic intervention. However, the indications for the use of BAE are undefined, especially in the cases of comorbid obesity; there are no clear algorithms and guidelines for its use.
 Conclusions. There have been no comprehensive studies of short-term, intermediate and long-term outcomes of BEA in Ukraine. This warrants the need to develop an optimal model for predicting the outcomes of both classical bariatric laparoscopic surgery with regulated gastric band and innovative BEA procedure in patients with comorbid obesity in post-pandemic period using anamnestic, clinical, biochemical and genetic predictors.