Prevention Of Specific Complications Research Articles

Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies

Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery. Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD. Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group 1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods. Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level). Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be noted that TT provides lower risk of complications due to significantly lower level of TSHR‑Ab in late postoperative period.

New Horizons. A New Paradigm for Treating to Target with Second-Generation Obesity Medications.

In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric American Association of Clinical Endocrinology (AACE) obesity guidelines and the diagnostic term of adiposity-based chronic disease (ABCD). Many complications require 10% to 20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced > 10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis, which are treated to biomarker targets that can be modified based on the clinical status of individual patients [ie, hemoglobin A1c (HbA1c), blood pressure, and low-density lipoprotein cholesterol (LDL-c)] to prevent the respective complications of these diseases.

Modern aspects of treatment of hiatal hernia and its main complications

The aim. To evaluate the features and results of minimally invasive surgical treatment of patients with hiatal hernia (HH) and its main complications using modern endoscopic and laparoscopic technologies. Materials and methods. The treatment results of 244 patients with HH and its main complications are given. 28 (11.5 %) patients had a combination of HH with Barrett’s esophagus, and 34 (13.9 %) patients had a combination of HH with esophageal stricture. In 62 patients with complications of HH, two-stage treatment tactics was used. Complete laparoscopic fundoplication was performed in 185 (75.8 %) patients, posterior partial Toupet fundoplication – in 59 (24.2 %) patients. Laparoscopic posterior crurography was performed in 198 (81.1 %) patients. In 7 (2.9 %) posterior crurography was supplemented by anterior. Teflon gaskets were used in 25 (10.3 %) patients during posterior crurography. Synthetic mesh prostheses were implanted in 14 (5.7 %) patients. Results. In patients with esophageal stricture, the effect was observed after the second session of bougienage or hydro-dilation in 70.6 % of cases, after the third session - in the remaining cases. In Barrett's esophagus, a single session of argon plasma coagulation was radical in 100 % of patients with a lesion size less than 1 cm and in 85 % of patients with lesions of 1 cm to 2 cm in size. Recurrence of type III HH occurred more often than type I. The surgery required sufficient mediastinal dissection and mobilization for an adequate esophagus pull-through. In the surgical treatment of type IV HH, the use of composite diaphragmatic meshes was considered. The effectiveness of antireflux surgical intervention, as well as prevention of specific complications was depended on the technical features of the fundoplication cuff formation. Conclusions. In the treatment of Barrett’s esophagus or esophageal stricture in combination with HH, the two-stage tactics is optimal: stage I – ablation or dilatation, and stage II – laparoscopic antireflux surgery. Laparoscopic fundoplication is an effective and safe method for treatment of patients with HH.