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Evolution of the gastric shunting operation

Objective. To study metabolic changes and peculiarities of mineral balance depending on the common loop length while constructing of the simulated model of gastric shunting with one anastomosis during 60 days. Materials and methods. Experimental simulation of gastric minishunting with one anastomosis of various length of bilio-pancreatic loop was constructed on the rats. In 10 rats the anastomosis was formatted on level of half of total length of small intestine (Group I), and also in 10 - a third part of general length of small intestine (Group II). Control Group consisted of 5 rats. The indices of the extra body mass loss and metabolic changes were compared. Results. In the rats of Group I the index of the body mass loss have constituted 16.6% (41.7 gm), and of the Group II -20.6% (53.2 gm). Lowering of indices of mineral and prion metabolism, comparing preoperative values, was observed in both Groups. Dystrophic changes in osseous tissue of vertebral bodies of lumbar vertebral column were noted in animals of both Groups, more pronounced - in Group II. Conclusion. The protein and mineral metabolism disorders may be observed not only in large resection volume, but in exclusion of half and more segment of small bowel from general transit, using gastric shunting, what lacks significant advantages in the extra body mass loss, but leads to more profound metabolic disorders.

Objective. To study a metabolic effect of distal gastric shunting with one anastomosis in patients, suffering morbid obesity (MO). Materials and methods. The results of surgical treatment of 53 patients, suffering MO, in whom in the clinic a distal gastric shunting with one anastomosis, were analyzed. The patients age range have varied from 27 to 66 yrs old. A median body mass index have constituted 53 kg/m2 (38 - 80 kg/m2). Metabolic syndrome have had all 53 (100%) patients, hypertensive disease, atherosclerotic cardiosclerosis, dyslipidemia - 30 (56.6%) patients, Pickwick syndrome - 4 (7.5%), diabetes mellitus Type II - 11 (20.8%). There were estimated the excessive body mass, laboratory indices - a НOMA index, the levels of insulin, C-peptide, lipids, general protein. Results. In a one year postoperatively a median index of the excessive body mass loss have constituted 67.1%, in 2 yrs - 76.4%. Preoperatively a НOMA index have constituted 8.02 conventional units, level of insulin - 21 mcU/ml, C-peptide - 4.2 ng/ml. Already in 3 mo after distal gastric shunting a НOMA index, the levels of insulin and C-peptide have normalized. Conclusion. Distal gastric shunting constitutes an effective method of surgical correction of MO, metabolic syndrome and in accordance to results is completely comparable with other bariatric operations, and they are technically easier to perform in patients, suffering morbid superobesity, using surgical access with 3 trocars.