Introduction. Nowadays, bariatric/metabolic surgery is recognized as the most effective method providing long-term sustainable weight loss in patients suffering from morbid obesity, as well as effective long-term effects on the course of obesity-related diseases, including type 2 diabetes mellitus. At the same time, this type of treatment places high demands on the qualifications of both the surgeon and the institution where bariatric/metabolic operations are performed.

Goal. The Russian Society of Bariatric Surgeons, together with the ROH, was tasked with developing criteria for surgical competence and requirements for medical institutions that provide safe and effective treatment for obese patients.

The main provisions. Every surgeon working with bariatric patients, regardless of the type of medical facility, requires the necessary level of training and experience in both general surgery and surgical gastroenterology. Along with a team of bariatric surgeons, it is extremely important to have associated specialists. Depending on the equipment, operating hours and staffing of the medical institution, three levels of bariatric surgery care are offered in accordance with international practice.: 1) primary bariatric institutions (PBU), 2) existing bariatric institutions (DBU), and 3) High–quality Bariatric Surgery Centers (Excellence Centers) – CVCS. The issue of accreditation of bariatric institutions by the ROBH is relevant for the coming years from the point of view of monitoring by the ROBH. Indications and contraindications for bariatric surgery are regulated by the latest edition of the Clinical Guidelines "Obesity" and the latest edition of the Clinical Guidelines "Type 2 Diabetes Mellitus in adults".

Conclusion. According to the experts of the Society of Bariatric Surgeons, the introduction of the above-mentioned positions into practice will contribute to improving the quality of bariatric services and will increase the safety of bariatric/metabolic surgery in the country.

Introduction. Given the limited efficacy of conservative treatment methods, bariatric surgery is now considered the most effective approach for achieving sustained weight loss and metabolic improvement in patients with morbid obesity. Currently, there is no clearly defined algorithm for selecting primary bariatric procedures, which significantly complicates decision-making for early-career bariatric surgeons and multidisciplinary teams. Most specialists rely on expert opinions from leading bariatric surgeons and clinical obesity treatment guidelines.

Materials and Methods. We analyzed contemporary approaches to optimal bariatric procedure selection based on clinical guidelines from major international and Russian organizations and current research data.

Results. Based on the comparative benefits, limitations, and patient-specific factors, we developed an algorithm for selecting primary bariatric procedures for patients with obesity and metabolic syndrome.

Conclusion. The proposed algorithm demonstrates that selection of primary bariatric surgery should be based on multiple factors affecting procedural safety and efficacy. Implementation of this algorithm helps standardize surgical decision-making while allowing personalized adaptation of surgical strategy according to individual patient characteristics, thereby reducing complication risks and improving outcomes.

Introduction. The rise of obesity in the 21st century has become a new challenge for doctors of various specialties around the world. Obesity, in addition to a pronounced cosmetic defect, is associated with a number of somatic diseases. Bariatric surgery is an effective treatment method. However, rapid weight loss leads to sagging subcutaneous fat and the formation of skin folds and aprons that require plastic surgery.

Purpose: to analyze the results of dermatopectomy operations performed in patients who had previously undergone bariatric surgical treatment.

Materials and methods. The multicenter retrospective study included 76 patients who underwent abdominoplasty in 2021-2024. All patients underwent bariatric surgery for obesity.

Results. Depending on the revealed abdominal configuration disorders, three types of operations were used: horizontal access with navel transfer, horizontal access with vertical component and navel transfer, and combined T-shaped access "big anchor". The number of complications in the postoperative period in patients after bariatric surgery in the anamnesis and rapid massive weight loss exceeds those after abdominoplasty without a burdened anamnesis.

Conclusion. Rapid weight loss after surgery leads to sagging skin and the formation of skin folds, which not only disrupt the appearance of the patient, but also make it difficult for self-care and predispose to the formation of purulent skin diseases. In order to avoid these complications, after weight stabilization, patients need to perform plastic surgery to restore the abdominal configuration.

Introduction. The number of bariatric surgeries performed is progressively increasing. However, rapid and massive weight loss leads to the same rapid formation of sagging skin folds, including in the area of the anterior abdominal wall, the complete elimination of which requires the intervention of a plastic surgeon. But dermatolipectomy after bariatric treatment has a number of significant differences from standard abdominoplasty.

The aim of the work: to search for and substantiate new methods of preventing complications after dermatolipectomy in patients with a history of metabolic surgery.

Materials and methods. The study included 10 patients aged 45 to 57 years who underwent classical abdominoplasty at Eva Clinic after previous bariatric surgery 1.5 to 2 years ago. The essence of the method is to measure the parameters of blood circulation in the epigastric arteries before and after the main stage of abdominoplasty, followed by an analysis of the data obtained to adopt an optimal suturing strategy. Ultrasound vascular doppler VD-260 was used to determine blood flow through the epigastric arteries.

Results. The only indicator that can indicate the possibility of flap ischemia after suturing is the ratio of Doppler readings before and after suturing. The before/ after ratio of 2.0 or more indicates the possibility of necrotic skin changes and requires additional mobilization of the skin flap in order to reduce tension.

Conclusion. This technique is an innovative method for predicting the healing process of postoperative wounds in plastic surgery, based on an objective assessment of microcirculation in tissues.

Introduction. Aim. To evaluate the effectiveness and safety of endoscopic botulinum toxin therapy in bariatric patients.

Methods. A prospective controlled study of 48 patients with varying degrees of obesity who underwent endoscopic injection of botulinum toxin into the stomach floor was conducted. A dynamic assessment of subjective status and objective data, including body weight, daily calorie intake and laboratory data, was performed.

Results. The greatest decrease in body weight was observed in overweight patients, whose body weight loss averaged 14% relative to baseline values. The decrease in body weight in patients with grade I and II obesity was 5% and 6.4%, respectively. The average daily calorie intake decreases significantly in the first week after the procedure and is significantly lower throughout the follow-up period relative to the baseline data. The clinical and laboratory evaluation revealed no significant complications or toxic effects of the procedure.

Conclusion. The gastric botox therapy is a safe and effective method of body weight correction for overweight patients in preoperative preparation for bariatric surgery.