Strategy for surgical treatment of patients with morbid obesity
https://doi.org/10.17238/2072-3180-2025-4-114-124
Abstract
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.
Supporting agencies: The work was supported by the Almazov National Research Medical Center of the Russian Ministry of Health.
About the Authors
A. E. Neimark
Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Neimark Alexander Evgenievich – PhD, Associate Professor.
197341, Akkuratova St. 2, St. Petersburg
P. A. Kotkov
Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Kotkov Pavel Aleksandrovich – PhD, Associate Professor.
2 Akkuratova St., St. Petersburg, 197341
D. H. Kalandarova
Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Kalandarova Diyora Khamroevna – PhD, Assistant.
197341, Akkuratova St. 2, St. Petersburg
B. V. Sigua
Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Sigua Badri Valerievich – Doctor of Medical Sciences, Professor.
197341, Akkuratova St. 2, St. Petersburg
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Review
For citations:
Neimark A.E., Kotkov P.A., Kalandarova D.H., Sigua B.V. Strategy for surgical treatment of patients with morbid obesity. Moscow Surgical Journal. 2025;(4):114-124. (In Russ.) https://doi.org/10.17238/2072-3180-2025-4-114-124
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