Introduction. Currently, biliopancreatic diversion (BPD) as the most effective bariatric surgery for the treatment of morbid obesity and related metabolic disorders is used relatively rarely. Also, there is no consensus about the indications, the timing of revisional operations after BPD.

Aim. General and comparative evaluation of the effectiveness and safety of revisional operations after BPD with sleeve gastrectomy (Hess-Marceau and SADI-s modifications).

Materials and methods. As a part of a prospective study in the period from 2003 to 2023, the results of surgical treatment of 810 patients with morbid obesity were evaluated, 529 of whom underwent BPD/DS, and 281 patients underwent SADI-s. Subsequently, 108 out of 810 patients underwent 116 revisions at different times after surgery. To eliminate side effects, elongations of functioning bowel segments were done. To improve the results of the primary operation – resection / plication of the small stomach, as well as shortening of the common and alimentary loops. In order to treat clinically significant bile reflux after SADI - reconstruction to BPD/DS was performed.

Results. In the BPD/DS group, 8,5 %, in the SADI-s group, 5,7 % of patients underwent revisional operations to improve results, and 8 (7,4 %) patients underwent more than 1 reconstructive surgery. 9 (20 %) reconstructions in the BPD/DS group and 7 (43,8 %) in the SADI-s group were performed simultaneously with abdominoplasty. 9,3 % of patients underwent secondary operations to treat complications and side effects after BPD/DS. In the SADI-s group, the need for restorations occurred much less frequently than in BPD/DS group.

Conclusion. When planning revisional operations, it is necessary to assess the possibility of influencing on both restrictive and hypoabsorptive components by performing preoperative radiopaque examination of the stomach and intraoperative measurement of small intestine segments. Restoration of the excluded small bowel segments allowed in all cases to eliminate the manifestations of complications, but usually led to weight regain, and therefore it is necessary to keep in mind the possibility of further revisions.

Introduction. Bariatric surgery is recognized as a highly effective and safe treatment for obesity and comorbid conditions. Nevertheless the postoperative period is associated with the risk of a number of complications, including gallstone disease (GSD). The reason of GSD is rapid weight loss due to surgical intervention. Currently, there are no standardized schemes for the prevention of cholelithiasis in bariatric patients. Moreover, sometimes implementation of this prevention remains the subject of discussion.

Aim. To present a literature review on the epidemiology of GBD and measures for its prevention after various types of bariatric interventions.

Materials and methods. The analysis of domestic and foreign literary sources appropriate for a given purpose on available Internet resources was carried out. More than 50 scientific publications were studied, 27 of them are listed in this article.

Results. The incidence of GSD after bariatric surgery ranges from 6,5 to 38 % (about 25 % on average), symptomatic cholelithiasis – from 3,3 to 17,5 %, the need for cholecystectomy – from 6,2 to 14,7 %. The appointment of UDCA at a dose of 500–600 mg per day for 6 or more months is an effective measure to prevent the development of cholelithiasis after all types of baritary operations. Prophylactic cholecystectomy is predominantly performed in patients with symptomatic cholelithiasis at the preoperative stage.

Introduction. Gastroesophageal reflux disease is a common complication in bariatric patients. Dissatisfaction with the quality of life and ineffectiveness of conservative therapy are the main reasons for repeated surgical intervention.

The purpose of the study. To develop antireflux bariatric surgery for the treatment of patients with obesity and concomitant GERD, to evaluate its effectiveness and safety.

Materials and methods. A prospective controlled study included 34 patients who underwent laparoscopic mini-bypass surgery with Nissen fundoplication with postoperative follow-up periods of up to three years. This study presents the technical aspects of the operation and analyzes the effectiveness and safety of the developed operation.

Results. According to the GERD–HRQL questionnaire, mini-bypass surgery with Nissen fundoplication showed high control over GERD phenomena at all stages of postoperative follow-up. According to the GIQLI questionnaire, the average score after surgical treatment increased by 54% in three years compared to the initial data. When evaluating the effectiveness of bariatric treatment according to the criteria of the BAROS system, it was found that "excellent and very good results" were mainly obtained during the entire period of postoperative follow-up.

Conclusion. The developed mini-bypass surgery with Nissen fundoplication is a safe, effective method of surgical treatment, and can be offered to patients with obesity and concomitant gastroesophageal reflux disease.

Introduction. Nowadays a sleeve gastrectomy (LSG) remains the most common bariatric procedure. An extremely important issue is the impact of this surgical intervention on the course of concomitant gastroesophageal reflux disease (GERD), especially in combination with the presence of hiatal hernia (HH).

Purpose of the study. To evaluate the effect of LSG in obese patients on the course of GERD.

Materials and methods of research. A retrospective analysis of the treatment outcomes of 54 patients who underwent PRV since May 2022. to June 2023 about obesity III Art. according to WHO (BMI> 35 kg/m²).

Results. LSG can be performed in patients with HH types 1 and 2, as well as with clinically insignificant forms of HH, and without worsening the course of GERD.

Conclusion. According to the results of the study, the standardized implementation of LSG provides a minimum percentage of reflux in the postoperative period, without the need for medical correction and repeated surgical interventions.

Introduction. The reverse arrangement of the internal organs (situs viscerus inversus) or transposition of the internal organs is a rare genetic autosomal recessive disease characterized by a mirror arrangement of the internal organs relative to the sagittal axis of the body. On a clinical example, the authors present an algorithm for preoperative examination and a feature of performing laparoscopic longitudinal resection of the stomach and one-stage cholecystectomy in the presence of situs viscerus inversus.

Description of the clinical case. A clinical case of a 45-year-old patient hospitalized for bariatric intervention is presented. At the stage of preoperative examination, as a find, a complete reverse arrangement of internal organs was revealed. In addition to routine examinations, the patient underwent MSCT of the abdominal organs. The patient was successfully performed laparoscopic sleeve resection of the stomach with simultaneous cholecystectomy. The implementation of the intervention itself required the mirror installation of endoscopic trocars, however, there was a clear preservation of anatomical landmarks. The stages of the operation and the performance of technical techniques did not differ radically from those in the “normal” arrangement of organs. The experience of performing these surgical interventions, increased attention and careful execution of all stages of the operation made it possible to avoid complications. The patient was discharged on the 5th day after the operation. Examined 2,5 months after the operation. He does not complain. Strictly observes the diet, takes vitamin and mineral complexes. The weight loss was 15 kg.

Introduction. Bariatric surgery is the most effective method of obesity treatment, improving glycemic control in metabolism disorders. Continuous glucose monitoring (CGM) is shown to be the most informative measurement in diabetes mellitus. There are data in the literature regarding the development of hypoglycemic episodes in the postoperative period. However, there is not enough data in the literature about perioperative CGM. The association of perioperative CGM with further hypoglycaemia requires further study.

Purpose of the study. To evaluate the perioperative CGM in a patient with morbid obesity and type 2 diabetes mellitus during bariatric surgery (gastric bypass).

Materials and methods. A patient with morbid obesity and type 2 diabetes mellitus underwent CGM, including 7 days before and after gastric bypass.

Results: In the first days of the postoperative period, according to CGM data, 5 hypoglycemic episodes with an average duration of 141 minutes were detected. 3 months after the operation, the patient also revealed hypoglycemic episodes.

Conclusion. It is impossible to exclude assotiation between perioperative hypoglycemia on CGM and further glycemic profile in patients after bariatric surgery.

Introduction. Obstruction of the gastroenteroanastomosis (GEA) is a complication specific to bariatric surgery, the tactics of combating which are not currently standardized, and the problem itself continues to be relevant and debatable.

The aim of the study was to study the features of the diagnosis and treatment of GEA obstruction after laparoscopic gastric bypass.

Materials and methods. A retrospective analysis of the results of 360 laparoscopic gastric bypasses performed at the FSCC FMBA of Russia for the period from 2019 to 2023 was carried out.

Results. In the early postoperative period, GEA obstruction developed in 6 patients (1.7%). In all cases, the complication was resolved conservatively within 3 to 6 days. In the long-term period, GEA obstruction was diagnosed in 9 patients (2.5%) within 28 to 74 days. In all cases, the complication was resolved by endoscopic bougienage and dilatation of the GEA. No one required surgical treatment.

Conclusions. GEA obstruction is a relatively rare complication of laparoscopic gastric bypass surgery, which can be effectively dealt with in a specialized center. If obstruction occurs in the immediate postoperative period, as a rule, conservative therapy is sufficient. With the development of GEA stricture in the long-term period, it is possible to achieve a satisfactory result using endoscopic techniques.

Introduction. The development of bariatric and metabolic surgery has led to the emergence of a category of patients who, for various reasons, require repeated surgical interventions.

The aim of the study was to analyze the results of the use of diversionary gastroschunt as a revision surgical intervention in patients with repeated weight gain and/or persistent biliary reflux after previously performed bariatric intervention.

Materials and methods. The study examined the possibility of using diversionary gastroschunt, D-OAGB as a revision surgical intervention in patients with repeated weight gain or persistent biliary reflux after previously performed bariatric intervention.

Results. Preliminary results show the effectiveness and safety of the technique. The technique of gastric bypass surgery with a long gastric reservoir and anastomosis according to the Ru represents a huge potential as a primary operation in patients with a BMI of more than 35 and the presence of gastroesophageal reflux disease.

Conclusions. Diverted gastric bypass (D-OAGB) as a revision surgical intervention in patients with repeated weight gain and/or persistent biliary reflux after previously performed bariatric intervention is a technique combining the advantages of technologies known in surgical gastroenterology and bariatric surgery. Further accumulation of clinical material with an objective assessment of long-term treatment results is necessary.

Introduction. Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery in the world. Gastroesophageal reflux disease (GERD) is most common post-SG complication. Post-SG patients with GERD refractory to proton pump inhibitors usually undergo anatomy-altering Roux-en-Y gastric bypass surgery which becomes the only treatment as usual.

Purpose: to analyze the factors for the development of GERD after SG and the surgical options for treatment. To propose an algorithm for the surgical treatment of GERD, depending on the cause of its development.

Materials and methods. A search and analysis of the literature in the Medline database (pubmed.org) evaluating the postoperative results of primary SG surgery was carried out. The review included meta-analyses, randomized and non-randomized trials. Key words in the search were: sleeve gastrectomy, gastroesophageal reflux disease, hiatal hernia, gastric bypass. A review of the methods of surgical treatment of GERD, depending on the etiological factors, was carried out.

Conclusion. Increased intragastric pressure, esophageal dysmotility, lower esophageal sphincter dystonia, concomitant hiatal hernia and the shape of the sleeve are major GERD factors. There is no universal method of surgical treatment GERD after SG, which has absolute effectiveness. The approach to solving the problem of GERD should be differentiated, that is, take into account the factors of its development. Repairing a hiatal hernia or gastric deformities such as strictures and dilations may help improve symptoms. With dysfunction of the lower esophageal sphincter, gastric bypass options should be considered, the most effective of which is RYGB.