mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2025-4-114-124mossj-1093Research ArticleБАРИАТРИЧЕСКАЯ ХИРУРГИЯBARIATRIC SURGERYСтратегия хирургического лечения больных с морбидным ожирениемStrategy for surgical treatment of patients with morbid obesityhttps://orcid.org/0000-0003-4925-0126НеймаркА. Е.NeimarkA. E.

Неймарк Александр Евгеньевич – кандидат медицинских наук, доцент. 

197341, ул. Аккуратова 2, Санкт-Петербург

Neimark Alexander Evgenievich – PhD, Associate Professor. 

197341, Akkuratova St. 2, St. Petersburg

sas_spb@mail.ruhttps://orcid.org/0000-0002-9762-9854КотковП. А.KotkovP. A.

Котков Павел Александрович – кандидат медицинских наук, доцент.

197341, ул. Аккуратова 2, Санкт-Петербург

Kotkov Pavel Aleksandrovich – PhD, Associate Professor.

2 Akkuratova St., St. Petersburg, 197341

kotkovdr@mail.ruhttps://orcid.org/0000-0002-8497-8553КаландароваД. Х.KalandarovaD. H.

Каландарова Диёра Хамроевна – кандидат медицинских наук, ассистент.

197341, ул. Аккуратова 2, Санкт-Петербург

Kalandarova Diyora Khamroevna – PhD, Assistant. 

197341, Akkuratova St. 2, St. Petersburg

diyorakalandarova931@gmail.comhttps://orcid.org/0000-0002-4556-4913СигуаБ. В.SiguaB. V.

Сигуа Бадри Валериевич – доктор медицинских наук, профессор.

197341, ул. Аккуратова 2, Санкт-Петербург

Sigua Badri Valerievich – Doctor of Medical Sciences, Professor.

197341, Akkuratova St. 2, St. Petersburg

dr.sigua@gmail.comФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution “V.A. Almazov National Medical Research Centre” of the Ministry of Health of the Russian FederationRussian Federation20251512202504114124Copyright © Неймарк А.Е., Котков П.А., Каландарова Д.Х., Сигуа Б.В., 20252025Неймарк А.Е., Котков П.А., Каландарова Д.Х., Сигуа Б.В.Neimark A.E., Kotkov P.A., Kalandarova D.H., Sigua B.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/1093

Введение. Единый валидированный подход к выбору вида бариатрического вмешательства по-прежнему остается предметом дискуссий, как и вопрос недостаточного снижения и послеоперационного возврата веса. Цель. Разработка и оценка эффективности дифференцированного подхода к выбору бариатрического вмешательства и интенсивности послеоперационного наблюдения у больных с морбидным ожирением. Материалы и методы. На первом этапе исследования проведена оценка результатов лечения группы сравнения в составе 502 больных, которым были выполнены продольная резекция желудка, гастрошунтирование с анастомозом по Ру и минигастрошунтирование без какого-либо унифицированного подхода. На основании данного анализа был сформулированы критерии к выбору бариатрической операции, апробированные в основной группе пациентов из 380 пациентов. Результаты. За счет внедрения алгоритма выбора бариатрического вмешательства, учитывающего наличие и выраженность психических расстройств, факторов ассоциированных с неудовлетворительным результатом метаболической хирургии, а также особенностей течения сахарного диабета и гастроэзофагеальной рефлюксной болезни, удалось добиться улучшения %EWL, регистрируемого к концу 1-го года наблюдения (с 58,7 до 65,6 %) с дальнейшим ростом разницы к 5 году за счет меньших значений процентного возврата веса. Получены лучшие результаты в основной группе в отношении сопутствующих нарушений углеводного обмена и гастроэзофагеальной рефлюксной болезни. Заключение. Разработанный алгоритм выбора бариатрического вмешательства и послеоперационного наблюдения, основанный на оценке психических, соматических характеристиках пациента и коморбидных состояниях можно рекомендовать к применению в клинической практике.

Introduction. The approach for choosing the type of bariatric intervention remains a controversial, as well as the issue of insufficient weight loss and postoperative weight regain. Aim. Development and outcomes of a personalized algorithm for bariatric procedure selection and postoperative management in morbid obesity. Development and evaluation of the effectiveness of a differentiated approach to the choice of bariatric intervention and the intensity of postoperative monitoring in patients with morbid obesity. Methods. The study was conducted in two stages. First, treatment outcomes were evaluated in a retrospect comparison group of 502 patients who underwent various bariatric procedures (sleeve gastrectomy, Roux-en-Y gastric bypass, mini gastric bypass) without a standardized selection protocol. The results gained from this evaluation were used to develop a structured selection algorithm, which was then validated in a prospective main cohort of 380 patients. Results. By implementing a bariatric surgery selection algorithm that considers mental disorders, factors associated with unsatisfactory metabolic surgery outcomes, and the characteristics of diabetes and gastroesophageal reflux disease, we achieved an improvement in %EWL one year after surgery (from 58,7 to 65,6 %), with a further increase in the difference after 5 years due to lower weight regain. Better results were achieved in the study group with respect to concomitant carbohydrate metabolism disorders and gastroesophageal reflux disease. Conclusion. The developed algorithm for selecting bariatric surgery and postoperative follow-up intensity-based on the patient's psychological and comorbidity profile is recommended for clinical practice.

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The authors declare that there are no conflicts of interest present.