Substantiation of expediency of a two-staged surgical treatment of morbid obesity

Keywords: morbid obesity; two-staged surgical treatment; оperative-anesthesiological risk

Abstract

Objective. To substantiate the expediency of a two-staged surgical treatment of morbid obesity (МО), using intragastric balloon (IGB) as a first stage.

Маterials and methods. There were examined and treated 97 patients, suffering МО (superobesity) and high operative-anesthesiological risk (Class ІІІ-ІV in accordance to ASA РS – American Society of Anesthesiologists Physical Status Classification System 2014) scale. The patients were treated in two stages: at the first one IGB was introduced endoscopically for 6 mo (main group, n = 60) and conservative therapy - during 6 mo, including diet, physical activity and behavioral consulting (control group, n = 37). On the second stage to patients of both groups a surgical treatment for MO was conducted.

Results. The average percent of excess weight loss (%EWL) in the main group of patients have constituted 22.69 ± 5.87 and statistically significantly (p < 0.001) have exceeded the index in patients of a control group. The level of operative-anesthesiological risk in accordance to ASA PS scale in the main group of patients have reduced statistically significantly (p<0.001), what served an indication for conduction of a second stage for the МО treatment in these patients. Аnalysis of the treatment efficacy, consisting of two stages, have shown, that in these patients a body mass have reduced at average by (83.31 ± 16.15) kg (minimally – by 43 kg, maximally – by 113 kg), %EWL at the end of complete course of a two-staged treatment have constituted at average 65.28 ± 6.65 (minimal – 53.61, maximal -  80.49).

Conclusion. Expediency of a two-staged treatment in patients with МО and high operative-anesthesiological risk was established: the IGB introduction in a first stage, аnd in a second one – performance of bariatric operation. If the IGB application have permitted to achieve the %EWL indices, which equals or exceeds  20, advantage must be given to restrictive types of bariatric operations, and while lesser than 20 – shunting bariatric intervention; while presence in patient with МО coexistent diabetes mellitus Type II, not depending from the %EWL indices, the advantage should be given to shunting bariatric intervention.

Author Biographies

O. Yu. Ioffe, Bogomolets National Medical University, Kyiv

Ioffe Oleksandr Yuliyovych, Ph.D., Professor,

Head of the Department of General Surgery #2,

Bogomolets National Medical University

  1. Shevchenko boulevard, 13, Kyiv, Ukraine, 01601

Tel.: +38 (044) 234-40-62

E-mail: new_surgery@ukr.net

ORCID: https://orcid.org/0000-0002-1306-7920

M. S. Kryvopustov, Bogomolets National Medical University, Kyiv

Kryvopustov Mykola Serhiiovych, Ph.D. student

Department of General Surgery #2,

Bogomolets National Medical University

Т. Shevchenko boulevard, 13, Kyiv, Ukraine, 01601

Tel.: +38 (044) 234-40-62

E-mail: mykola.kryvopustov@nmu.ua

ORCID: https://orcid.org/0000-0002-8221-5106

Yu. P. Tsiura, Bogomolets National Medical University, Kyiv

Tsiura Yurii Petrovych, Ph.D., Assistant professor

Department of General Surgery #2,

Bogomolets National Medical University

Т. Shevchenko boulevard, 13, Kyiv, Ukraine, 01601

Tel.: +38 (044) 234-40-62

E-mail: lekar_1974@yahoo.com

ORCID: https://orcid.org/0000-0001-6651-8564

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Published
2018-08-30
How to Cite
Ioffe, O. Y., Kryvopustov, M. S., & Tsiura, Y. P. (2018). Substantiation of expediency of a two-staged surgical treatment of morbid obesity. Klinicheskaia Khirurgiia, 85(8), 49-52. https://doi.org/10.26779/2522-1396.2018.08.49
Section
General Problems of Surgery

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