Search

It was performed a comparative analysis of treatment of 62 patients who were operated for morbid obesity. Patients were divided into 3 groups depending on kind of surgery: jejunal-iliac intestinal bypass, restrictive operations and combined operations. The complications in early postoperative period were diagnosed in 16.6% of patients after jejunal-iliac intestinal bypass and in 10% of patients after combined operations. Regardless of the kind of surgery there was rapid reduction of the body mass in the first year of observation with gradual increase of weight by an average of 5% in the subsequent period. The highest rate of weight loss by the second year was revealed after combined operations (up to 73.4%). Thus it was 1.1 times more than after jejunal-iliac intestinal bypass and 1.3 times more than after restrictive operations.

The study was designed to evaluate external respiratory function (ERF) and cardiovascular function based on AP measurements, results of 24 hour AP monitoring, treadmill test, and ECG during weight loss therapy in patients with excess body mass. A total of 93 patients with grade 2-3 obesity were examined including 41 (39.8%) with type 2 diabetes mellitus (DM). Group 1 consisted of patients with constitutive exogenous obesity, group 2 of patients with constitutive exogenous obesity and DM, group 3 was used as control. Follow-up studies were conducted after 6 and 12 months. Patients of groups 1 and 2 showed positive dynamics of hemodynamic characteristics related to the loss of weight including significant reduction of heart rate, systolic and diastolic indices of hypertonic loading, specific peripheral vascular resistance, and left ventricular mass. Simultaneously, cardiac index and ERF increased while vital lung capacity, forced vital capacity, and forced respiratory volume in the first second returned to normal values. It is concluded that reduction of body weight has positive effect on ERF dynamics and hemodynamic characteristics in patients with constitutive exogenous obesity.

The results of the gastric morphofunctional state after the gastric banding operation performance were analysed. In the late follow-up period after the operation there were not noted the severe gastric changes as well as its function disorder.

20 patients with obesity were examined. Their weight was increased as compared with ideal values by 30-140%. The patients were characterized by anxious or depressive disturbances (Spilberger's and Beck tests) and alterations of alimentary behaviour in form of prevalence of emotional and external alimentary behaviour (EMAB and EAB, respectively). The study of cognitive negative variations (CNV) revealed the decrease of late wave's area, which correlated reversely with levels of anxiety, depression and EMAB expression. The Isolipan administration (15 mg, 2 times/daily during 3 months) together with hypocaloric diet resulted in average weight loss equal to 12.3 kg in the whole group. These changes correlated well with normalization of both alimentary behaviour (in the form of decrease of EMAB and EAB indices) and emotional state, and increase of decreased late CNV with disappearance of pathological psycho-physiological correlations between CNV and emotional state.

There is a marked decrement in physical performance of those patients with III to IV grade obesity as compared to apparently healthy volunteers going into training. Deficient reserve capabilities of the system for utilization of oxygen and oxygen transport appear to be those factors determining and limiting physical fitness of obese individuals. Exercise testing involving recording of indices for gas exchange in real time appears to be a valuable method of diagnosis of particular features of oxygen supply in patients with III to IV grade obesity, providing a very helpful information.

The authors analyse experience in the treatment of 415 patients with extreme alimentary-constitutional obesity (ACO) by operation for formation of a small stomach (FSS). Seventy-five patients were followed up and examined 3-5 years after the operation. FSS leads to stable and significant loss of body weight. Its degree depends on the diameter of the anastomosis between the proximal and distal parts of the stomach and the initial excess of body weight. The working capacity of the patients is restored in the late-term postoperative periods and diseases attendant to obesity disappear or take a milder course. The success of the treatment is determined significantly by the correct choice of the patients for surgery. Operations for FSS may be repeated for very strict indications in specialized clinics experienced in the treatment of patients with obesity.

An analysis is presented of ECG of 68 patients with obesity (grade III-IV) before the operation of jejunoileal shunting and 1-2, 3-5 and 6-10 years after surgery. It was found that the main changes in the cardiovascular system occur during the first 2 years, i.e. during the period of body mass reduction. The importance of ECG in the diagnosis of hypertrophy of different compartments of the heart in obesity of grade III-IV.

Histological study of biopsy specimens taken from the liver of 96 patients during operation for formation of a "small stomach" revealed fatty dystrophy of the liver in 93 patients (96.9%) which was attended by marked inflammatory and fibrous changes in 68 (70.8%) of them and by disturbed lobar structure of the liver (cirrhosis) in 2 patients (2.1%). Biochemical blood tests failed to show the pattern of the pathological changes before the operation. Study of the hepatobiliary system with methionine-75Se was the only method by which protein and pigment metabolism in the liver could be appraised. Examination of patients during 3 postoperative years showed a positive dynamics of changes in biochemical blood tests and improved protein metabolism in the hepatocytes according to the results of scanning of the liver with methionine-75Se. Thirteen repeated studies of the hepatic tissue collected from patients in different periods after operation for the formation of a "small stomach" showed a significant diminution of fatty dystrophy and inflammation of the parenchyma. The level of portal tract inflammation and portal fibrosis did not change. The findings suggest that there is an improved functional and morphological condition of the liver in weight loss caused by operation for the formation of a "small stomach", which allows this type of surgical intervention to be recommended for the treatment of patients with alimentary-constitutional obesity and initially diminished compensatory capacities of the liver.

The authors conducted a comparative analysis of the results of surgical treatment of patients with alimentary-constitutional adiposity (ACA) of extreme degrees. Operation for the formation of a small stomach (SSF) was carried out in 41 patients. The results in the same patients were analysed in postoperative periods of more than 2 years. The patients were divided into 2 groups. The first group was composed of 22 patients with morbid obesity and an average body weight of 140.2 +/- 4.47 kg (101.4 +/- 3.83% excess weight). The second group was made up of 19 patients with an average body weight of 170.2 +/- 6.5 kg (average excess weight 169.8 +/- 7.03%). The average weight loss in the first group was 41.9 kg (59.9% loss of excessive weight), the average weight loss in patients with hyperadiposis (second group) was 62.9 kg (99.4% loss of excessive weight). The results of operation for SSF for reducing body weight in patients with adiposity are better than those of vertical gastroplasty.

The authors examined 131 patients with degree III-IV alimentary-constitutional obesity before and after operation for formation of a "small stomach". The average body weight of the patients before surgery was 145 +/- 2.28 kg. In the first 12 postoperative months it reduced by 41.9 +/- 1.76 kg as compared to the initial weight. Diminution of body weight in the second year was statistically insignificant. All patients underwent endoscopy of the esophagus and stomach before and after the operation with appraisal of the degree of macroscopic changes of the mucous membrane. The incidence of chronic gastritis and esophagitis reduced in the postoperative late-term periods more than 1.5 times, that of erosive lesions more than 10 times. Targent measurement of the transmural potential difference (TPD) of the esophagus and stomach was conducted in 36 patients. The TPD value is much less in patients with obesity than in the control group of healthy individuals. After operation the TPD value grows significantly which is due to changes of the diet regimen, reduced amount of the ingested food, reduction of body weight, and improved processes of microcirculation in the mucous membrane of the gastrointestinal tract.

The function of external respiration, gas and ABB of blood, hemodynamics of the lesser circulation were studied during abdominal operations in patients with the IV degree obesity performed under conditions of epidural anesthesia with spontaneous respiration. On the basis of clinical and laboratory findings a conclusion was made on the adequacy of the method of epidural anesthesia with spontaneous respiration resulting in a considerably less amount of pulmonary complications.

The article analyses the results of surgical treatment of alimentary-constitutional obesity in 207 patients by means of operation for formation of a "miniature stomach". Total postoperative mortality was 2.4%. This index was 4.2% in the period when the method was mastered and 0.89% for the next 112 operations. It is shown that the operation for formation of a "miniature stomach" leads to a significant and stable loss of body weight, recovery from concomitant diseases or essential diminution of their severity, it alters the patients' life for the better and makes it possible for many of them to resume work.

Combined anesthesia with Ketalar and standard neuroleptanalgesia were used in obese patients with high risk of the development of hepatic insufficiency in operations of jejunoileoshunts. The investigation has shown the both kinds of intravenous anesthesia to be quite acceptable for this category of patients.

Postoperative decrease of the body mass was studied in 105 patients with massive obesity subjected to operation of jejunoileoshunting. Loss of the body mass was proportional to its initial value, inversely proportional to the length of the functioning portion of the ileum. In men the degree of postoperative loss of the body mass was more considerable than in women.

Epidural anesthesia with spontaneous respiration was used in 86 obese patients with the excessive body weight 130% more than the ideal weight. The minimum influence of epidural anesthesia upon oxygenation of the arterial blood in spontaneous respiration with the atmospheric air during abdominal interventions was noted. This kind of anesthesia decreased the risk of development of toxic complications characteristic of general anesthesia and gave less intraoperative load upon the cardio-vascular system of obese patients. The results obtained allow considering the epidural anesthesia to be the method of choice in very obese patients during operations on organs of the abdominal cavity.