Perekhrestenko O. Sleeve gastrectomy and biliopancreatic diversion in Hess-Marceau modification in surgical treatment of morbid obesity (clinical and experimental study)

The dissertation is devoted to the problem of surgical treatment of patients with morbid obesity. The results of clinical and experimental studies have made it possible to evaluate and improve sleeve gastrectomy and biliopancreatic diversion in Hess-Marceau modification, optimize management strategy of bariatric patients and substantiate new approaches to solve the problem of morbid obesity. The globalization of the obesity problem with rapid increase in the number of patients requiring bariatric surgery substantiated the relevance of the study. In according to study results morbid obesity was associated with high incidence of comorbidities and metabolic disorders that required radical and comprehensive correction. It has been proved that, despite the extremely high effectiveness of biliopancreatic diversion in Hess-Marceau modification, the use of this procedure should be limited due to the high frequency of severe long-term metabolic postoperative complications. It was also established that the balance of efficiency and safety of laparoscopic sleeve gastrectomy allows considering this operation as a priority (in the context of comparison of two procedures) for the majority of patients with morbid obesity. The results of study showed that among the mechanisms of metabolic efficacy of two indicated bariatric procedures reduction of chyme transit time to ileocecal valve zone has important role. It has been proved that using of P-POSSUM in bariatric surgery is inappropriate because of a significant overestimation the risk of early postoperative complications. A number of technical improvements of surgical procedures, which significantly reduced the incidence of postoperative complications, have been developed and implemented. The advantages of laparoscopic access for sleeve gastrectomy were demonstrated. The tactic for prevention, diagnostic and treatment of complications of sleeve gastrectomy and biliopancreatic diversion in Hess-Marceau modification has been improved. The expediency of using two-stage tactics of surgical treatment and prolonged multidisciplinary monitoring of bariatric patients has been demonstrated.