mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2022-1-9-20mossj-526Research ArticleБАРИАТРИЧЕСКАЯ ХИРУРГИЯBARIATRIC SURGERYОжирение первой степени – фокус на хирургиюClass I obesity – focus on surgeryhttps://orcid.org/0000-0001-8708-9455ЦепковскийА. C.TsepkovskyA. S.

 Цепковский Александр Сергеевич

 г. Москва, 107392, г. Москва, ул. Малая Черкизовская 

 Tsepkovsky Alexander Sergeevich

 Moscow, Russia, M.Cherkizovskaia 7, 107392 

CAS_82@mail.ruhttps://orcid.org/0000-0001-6592-1036ЯшковЮ. И.YashkovY. I.

 Яшков Юрий Иванович – доктор медицинских наук

1111123 г. Москва, шоссе Энтузиастов, дом 62, строение 1 

 Yashkov Yuri Ivanovich – MD, PhD

Shosse Entusiastov, 62; Moscow,11112 

yu@yashkov.ruhttps://orcid.org/0000-0002-1339-4868ЕвдошенкоВ. В.EvdoshenkoV. V.

 Евдошенко Владимир Викторович – доктор медицинскихнаук, профессор 

 117997,  г. Москва, ул. Островитянова, д. 1 

 Evdoshenko Vladimir Viktorovich – MD, PhD, Professor.

 Moscow,  Ostrovitianova 1, 117997 

bariatric@mail.ruhttps://orcid.org/0000-0002-4472-3142БорданН. С.BordanN. S.

 Бордан Наталья Семеновна – кандидат медицинских наук

105066, г. Москва, Ольховская ул., д. 27 

 Bordan Natalia Semenovna – Ph.D. in Medicine

Olhovskaia 27, Moscow, 105066

socetanie@mail.ruФГБ ВОУ ВО Военно-медицинская академия им. С.М. Кирова (филиал г. Москва)РоссияS. M. Kirov Military Medical Academy (Moscow branch)Russian FederationАО «Центр эндоскопии и литотрипсии»РоссияThe Center of Endosurgery and LithotripsyRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России; АО «Институт пластической хирургии и косметологии»РоссияPirogov Russian National Research Medical University; Institute of Plastic Surgery and CosmetologyRussian Federation20222604202201920Copyright © Цепковский А.C., Яшков Ю.И., Евдошенко В.В., Бордан Н.С., 20222022Цепковский А.C., Яшков Ю.И., Евдошенко В.В., Бордан Н.С.Tsepkovsky A.S., Yashkov Y.I., Evdoshenko V.V., Bordan N.S.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/526

В статье проанализирована современная тенденция расширения показаний к бариатрическим операциям для пациентов с ожирением начальной степени, ввиду возможности развития у них ассоциированных с ожирением заболеваний и метаболических нарушений, а также социально-психологических проблем и снижения качества жизни. На основании литературных данных PubMed, Medline, Embase, Elibruary, проведена оценка эффективности и безопасности хирургических методов лечения ожирения при индексе массы тела (ИМТ) менее 35 кг/м2.

Предложено определить следующие показания для оперативного лечения начальной степени ожирения: 1) наличие сахарного диабета 2 типа при недостаточной эффективности гликемического контроля сахароснижающими препаратами или инсулином и сохранения адекватной инкреторной функции поджелудочной железы; 2) прогрессирующее по мере повышения ИМТ нарушение менструального цикла и фертильности; 3) абдомино-висцеральная форма ожирения, в том числе, без метаболических нарушений, в случае наследственной предрасположенности к их развитию; 4) психологическая и социальная дезадаптация, значительно снижающая качество жизни (психологическое неприятие лишнего веса, дисморфофобия, булимия); 5) недостаточный эффект или его отсутствие от длительного консервативного лечения ожирения I степени.

Te bariatric and metabolic surgery for patients with non-severe obesity is steel controversial. But now we have a current trend of expanding indications for this group all over the world. Based on the literature data of PubMed, Medline, Embase, ELIBRUARY, the possibility of developing obesity-associated diseases, as well as socio-psychological problems and a decrease in the quality of life in patients with initial obesity was analyzed. In addition, we analyzed efcacy and safety of bariatric procedures in patients with body mass index less than 35 kg/m2, including ones without metabolic disorders. Indications for surgery are suggested: 1) type 2 diabetes mellitus with insufcient effectiveness of glycemic control with hypoglycemic drugs or insulin and maintaining adequate pancreatic endocrine function; 2) progressive menstrual and fertility disorders as BMI increases; 3) abdomino-visceral form of obesity including without metabolic disorders in case of hereditary predisposition to their development; 4) psychological and social maladaptation, signifcantly reducing the quality of life (psychological rejection of excess weight, dysmorphophobia, bulimia) 5) insufcient effect or its absence from long-term (1 year) conservative treatment.

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