mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/issn2072-3180.2020.4.52-55mossj-432Research ArticleБАРИАТРИЧЕСКАЯ ХИРУРГИЯBARIATRIC SURGERYЗАДНЯЯ КРУРОРАФИЯ И ФОРМИРОВАНИЕ АНТИРЕФЛЮКСНОЙ МАНЖЕТЫ КРУГЛОЙ СВЯЗКОЙ ПЕЧЕНИ КАК ВАРИАНТ ВЫБОРА МЕТОДА ЛЕЧЕНИЯ ГЭРБ ПОСЛЕ ПРОДОЛЬНОЙ РЕЗЕКЦИИ ЖЕЛУДКАPOSTERIOR CRURORAPHY AND ANTIREFLUX CUFF FORMATION WITH THE ROUND LIGAMENT OF THE LIVER AS A METHOD OF GERD TREATMENT AFTER GASTRIC SLEEVE SURGERYБуриковМ. А.BurikovM. A.

Буриков Максим Алексеевич — заведующий хирургического отделения, Руководитель центра хирургии ожирения и сахарного диабета II, кандидат медицинских наук

344023, Ростов-на-Дону, ул. Пешкова, 34

Burikov Maksim Alekseevich — Head of the Surgical Department, Head of the Center of surgery for obesity and type 2 diabetes mellitus, PhD in Medicine

344023, Peshkova str., 34, Rostov-on-Don

burikovm@gmail.comСказкинИ. В.SkazkinI. V.

Сказкин Иван Владимирович — заведующий операционным блоком центра хирургии ожирения и сахарного диабета II, врач-хирург, кандидат медицинских наук

344023, Ростов-на-Дону, ул. Пешкова, 34

Skazkin Ivan Vladimirovich — Head of the operating unit of the Center of surgery for obesity and type 2 diabetes mellitus, surgeon, PhD in Medicine

344023, Peshkova str., 34, Rostov-on-Don

skazkini@gmail.comШульгинО. В.ShulginO. V.

Шульгин Олег Владимирович — врач-хирург центра хирургии ожирения и сахарного диабета II

344023, Ростов-на-Дону, ул. Пешкова, 34

Shulgin Oleg Vladimirovich — Surgeon of the Center of surgery for obesity and type 2 diabetes mellitus

344023, Peshkova str., 34, Rostov-on-Don

shoolgin@gmail.comКинякинА. И.KinyakiA. I.

Кинякин Александр Игоревич — врач-хирург центра хирургии ожирения и сахарного диабета II

344023, Ростов-на-Дону, ул. Пешкова, 34

Kinyakin Aleksandr Igorevich — Surgeon of the Center of surgery for obesity and type 2 diabetes mellitus

344023, Peshkova str., 34, Rostov-on-Don

iskander0307@gmail.comЛукашевО. В.LukashevO. V.

Лукашев Олег Викторович – врач-хирург центра хирургии ожирения и сахарного диабета II

344023, Ростов-на-Дону, ул. Пешкова, 34

Lukashev Oleg Viktorovich — Surgeon of the Center of surgery for obesity and type 2 diabetes mellitus

344023, Peshkova str., 34, Rostov-on-Don

lukashevov@gmail.com«Ростовская клиническая больница» Федерального государственного бюджетного учреждения здравоохранения «Южный окружной медицинский центр Федерального медико-биологического агентства»РоссияRostov Clinical Hospital of South District Medical Center of Federal Medicine and Biology AgencyRussian Federation202009032021045255Copyright © Буриков М.А., Сказкин И.В., Шульгин О.В., Кинякин А.И., Лукашев О.В., 20212021Буриков М.А., Сказкин И.В., Шульгин О.В., Кинякин А.И., Лукашев О.В.Burikov M.A., Skazkin I.V., Shulgin O.V., Kinyaki A.I., Lukashev O.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/432

Введение: по данным литературы, развитие ГЭРБ и миграция рукава в заднее средостение, после операций ПРЖ и SADI-S колеблется от 7 до 30 % [13]. При диагностированном у пациентов ГЭРБ до операции нет четких указаний по хирургической тактике [8]. Предложено несколько вариантов выполнения операции в том числе, перевод операции в RYGB или MGB, а также консервативное лечение в послеоперационном периоде с применением препаратов протонной помпы, Н2-блокаторов, прокинетиков, дезоксихолевой кислоты, которое не всегда приводит к успеху [15]. Решение этого вопроса, по нашему мнению, является актуальной задачей современной бариатрической хирургии.Цель. Возможность улучшить качество жизни пациентов, перенесших ПРЖ и SADI-S при развитии ГЭРБ, а также снижение количества осложнений в послеоперационном периоде (рефлюкс-эзофагит, пищевод Баретта).Материалы исследования: в хирургическом отделении РКБ за период с 2016 по 2019 годы выполнено 379 ПРЖ и 173 SADI-S по поводу морбидного ожирения. У 52 пациентов в различные сроки после операции ПРЖ и SADI-S, развился ГЭРБ с развернутой клинической картиной, что у 6 пациентов потребовало хирургической коррекции.При ревизии выполнялась задняя крурорафия, укрепление пищеводного отверстия диафрагмы сетчатым имплантом и формировалась антирефлюксная манжета круглой связкой печени.Результаты: в послеоперационном периоде от трех месяцев до полутора лет не было отмечено рецидивов рефлюкс-эзофагита. Все симптомы заболевания после ревизионных антирефлюксных операций регрессировали наряду с повышением качества жизни.

Background. According to the literature, the development of GERD and migration of the sleeve to the posterior mediastinum after gastric sleeve surgery (GSS) and SADI-S surgery ranges from 7 to 30% [13]. When GERD is diagnosed in patients before surgery, there are no clear instructions on surgical tactics [8]. Several surgical options are suggested, including surgery conversion to RYGB or MGB, as well as conservative treatment with proton pump inhibitors, H2-blockers, prokinetics, and deoxycholic acid in the postoperative period, which is sometimes unsuccessful [15]. We consider the solution of this problem an urgent task of modern bariatric surgery.Objective. Improving the quality of life of patients developing GERD after GSS and SADI-S, as well as reducing the number of complications in the postoperative period (reflux esophagitis, Barrett's esophagus).Material and methods. 379 GSS and 173 SADI-S procedures for morbid obesity were performed in the surgical department of RCH in 2016–2019. 52 patients developed full-blown GERD at various times after the surgery, and it required surgical correction in 6 of them.Revision involved posterior cruroraphy, strengthening of the esophageal hiatus with a mesh implant and the antireflux cuff formation with the round ligament of the liver.Results. No relapses of reflux esophagitis were registered within the postoperative period from three months to 1.5 years. After the revision antireflux surgeries, all symptoms of the disease regressed, and the quality of life of patients improved.

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