asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-043asurgery-409Research ArticleБАРИАТРИЧЕСКАЯ ХИРУРГИЯBARIATRIC SURGERYДинамика саркопении после гастроеюношунтирования по Ру у пациентов с морбидным ожирениемDynamics of sarcopenia after Roux-en-Y gastric bypass in patients with morbid obesityhttps://orcid.org/0000-0002-2108-2362ХитарьянА. Г.KhitaryanA. G.

Хитарьян Александр Георгиевич - д.м.н., профессор, заслуженный врач России, заведующий хирургическим отделением, КБ «РЖД-Медицина» города Ростов-на-Дону; заведующий кафедрой хирургических болезней №3, Ростовский ГМУ.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Alexander G. Khitaryan - Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Head of the Surgical Department, Clinical Hospital “RZD-Medicine” in the City of Rostov-on-Don; Head of the Department of Surgical Diseases No. 3, RSMU.

92A, Varfolomeev St., Rostov-on-Don, 344011; 29, Nakhichevansky Lane, Rostov-on-Don, 344022

khitaryan@gmail.comhttps://orcid.org/0000-0002-3127-9935АбовянА. А.AbovyanA. A.

Абовян Арутюн Араратович - врач-хирург хирургического отделения, Клиническая больница «РЖД-Медицина» города Ростов-на-Дону; ассистент кафедры хирургических болезней №3, ГМУ.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Arutyun A. Abovyan - Surgeon of the Surgical Department, Clinical Hospital “RZD-Medicine” in the City of Rostov-on-Don; Assistant of the Department of Surgical Diseases No. 3, RSMU.

92A, Varfolomeev St., Rostov-on-Don, 344011; 29, Nakhichevansky Lane, Rostov-on-Don, 344022

abovyan97@mail.ruhttps://orcid.org/0000-0001-7787-4919МежунцА. В.MezhuntsA. V.

Межунц Арут Ваграмович - к.м.н., врач-хирург хирургического отделения, Клиническая больница «РЖД-Медицина» города Ростов-на-Дону; ассистент кафедры хирургических болезней №3, Ростовский ГМУ.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Arut V. Mezhunts - Cand. Sci. (Med.), Surgeon of the Surgical Department, Clinical Hospital “RZD-Medicine” in the City of Rostov-on-Don.

92A, Varfolomeev St., Rostov-on-Don, 344011; 29, Nakhichevansky Lane, Rostov-on-Don, 344022

arut.mezhunts@mail.ruhttps://orcid.org/0000-0003-3782-2860ОреховА. А.OrekhovA. A.

Орехов Алексей Анатольевич - к.м.н., врач-хирург хирургического отделения, Клиническая больница «РЖД-Медицина» города Ростов-на-Дону; доцент кафедры хирургических болезней №3, Ростовский ГМУ.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А; 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Alexey A. Orekhov - Cand. Sci. (Med.), Surgeon of the Surgical Department, Clinical Hospital “RZD-Medicine” in the City of Rostov-on-Don; Associate Professor of the Department of Surgical Diseases No. 3, RSMU.

92A, Varfolomeev St., Rostov-on-Don, 344011; 29, Nakhichevansky Lane, Rostov-on-Don, 344022

orekhov_aa@rostgmu.ruhttps://orcid.org/0009-0004-9840-7825КарукесР. В.KarukesR. V.

Карукес Роман Викторович - к.м.н., заведующий отделением хирургии.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А

Roman V. Karukes - Cand. Sci. (Med.), Head of the Surgical Department.

92A, Varfolomeev St., Rostov-on-Don, 344011

karukes@yandex.ruhttps://orcid.org/0000-0002-0077-1273РогутА. А.RogutA. A.

Рогут Александр Александрович - врач-хирург хирургического отделения.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92А

Alexander A. Rogut - Surgeon of the Surgical Department.

92A, Varfolomeev St., Rostov-on-Don, 344011

Sanek6453@mail.ruХитарьянВ. А.KhitaryanV. A.

Хитарьян Вера Александровна - студент лечебно-профилактического факультета.

344022, Ростов-на-Дону, пер. Нахичеванский, д. 29

Vera A. Khitaryan - Student of the Treatment and Prevention Faculty.

29, Nakhichevansky Lane, Rostov-on-Don, 344022

veralyapina02@gmail.comКлиническая больница «РЖД-Медицина» города Ростов-на-Дону; Ростовский государственный медицинский университетРоссияClinical Hospital “RZD-Medicine” in the City of Rostov-on-Don; Rostov State Medical UniversityRussian FederationКлиническая больница «РЖД-Медицина» города Ростов-на-ДонуРоссияClinical Hospital “RZD-Medicine” in the City of Rostov-on-DonRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation2024160520242117482Copyright © Хитарьян А.Г., Абовян А.А., Межунц А.В., Орехов А.А., Карукес Р.В., Рогут А.А., Хитарьян В.А., 20242024Хитарьян А.Г., Абовян А.А., Межунц А.В., Орехов А.А., Карукес Р.В., Рогут А.А., Хитарьян В.А.Khitaryan A.G., Abovyan A.A., Mezhunts A.V., Orekhov A.A., Karukes R.V., Rogut A.A., Khitaryan V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/409Введение

Введение. Гастроеюношунтирование по Ру является одной из самых популярных бариатрических операций. Однако недостаточно изученным остается влияние различных длин алиментарных и билиопанкреатических петель на результаты гастроеюношунтирования по Ру при максимальном рестриктивном компоненте.

Цель

Цель. Сравнить отдаленные результаты гастроеюношунтирования по Ру с максимальным рестриктивным компонентом при различных длинах алиментарных и билиопанкреатических петель.

Материалы и методы

Материалы и методы. В ретроспективное исследование были включены результаты лечения 170 пациентов: 98 (57,6%) – в группу гастроеюношунтирования по Ру с длинными алиментарными и билиопанкреатическими петлями, 72 (42,4%) – в группу с короткими петлями не менее чем через 24 мес. после операции (медиана наблюдения – 38 мес.). В первой группе длины алиментарных и билиопанкреатических петель составляли 150 и 100 см, во второй группе – 100 и 60 см соответственно. Всем пациентам в дооперационном периоде проводился стандартный комплекс обследования с дополнительным определением индекса массы скелетной мускулатуры методом биоимпедансометрии. Проводилась оценка размера гастроэнтероанастомоза через 12 мес. после операции с помощью фиброгастроскопии.

Результаты

Результаты. В обеих группах были получены хорошие сопоставимые результаты снижения массы тела и контроля сопутствующих заболеваний. Распространенность умеренной саркопении в группе гастроеюношунтирования по Ру с длинными петлями составила 24,5% (19,4% – в дооперационном периоде), выраженная саркопения наблюдалась у 3% исследуемых (исходно выраженной саркопении выявлено не было ни у одного пациента). Прогрессирование саркопении встречалось преимущественно у пожилых пациентов, а также у страдающих сахарным диабетом 2-го типа и исходными признаками саркопении. В группе гастроеюношунтирования по Ру с короткими петлями встречаемость саркопении возросла с 13 до 16% (разница статистически незначима). Выраженной саркопении в данной группе после операции выявлено не было.

Заключение

Заключение. При наличии у пациентов признаков умеренной саркопении по данным биоимпедансометрии, сахарного диабета 2-го типа, а также у пожилых целесообразно выполнение гастроеюношунтирования по Ру с минимальным мальабсорбтивным и максимальным рестриктивным компонентом, что позволяет добиться хороших результатов с точки зрения снижения массы тела и ремиссии сопутствующих заболеваний, а также избежать развития мальабсорбтивных осложнений, в том числе саркопении.

Introduction

Introduction. Roux-en-Y gastric bypass (RYGB) is one of the most popular bariatric procedures. However, the Impact of alimentary and biliopancreatic loops lengths on the results of Roux-En-Y Gastric Bypass with a maximum restrictive component remains insufficiently studied.

Aim

Aim. To compare the long-term results of RYGB with a maximum restrictive component at different lengths of alimentary and biliopancreatic loops.

Materials and methods

Materials and methods. Our retrospective study included 170 patients: 98 (57.6%) in the group with long alimentary and biliopancreatic loops, 72 (42.4%) in the group with short loops. Follow-up examinations were carried out with a follow-up period of at least 24 months (median follow-up 38 months). In the first group, the lengths of the alimentary and biliopancreatic loops were 150 and 100 cm, in the second group – 100 and 60 cm respectively. In the preoperative period, all patients underwent a standard set of examinations with an obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. The size of the gastroenteroanastomosis was assessed 12 months after surgery using fibrogastroscopy.

Results

Results. Both groups showed good results in weight loss and control of associated diseases. The prevalence of moderate sarcopenia in the group of RYGB with long loops was 24.5% (19.4% in the preoperative period), severe sarcopenia was observed in 3% of the subjects (initially severe sarcopenia was not detected in any patient). In the group of RYGB with short loops, the incidence of sarcopenia increased from 13 to 16% (the difference is statistically insignificant). No pronounced sarcopenia was detected in this group after surgery.

Conclusion

Conclusion. If patients have signs of moderate sarcopenia according to bioelectrical impedance analysis, type 2 diabetes mellitus, as well as in the elderly, it is advisable to perform RYGB with a minimal malabsorptive and maximum restrictive component.

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The authors declare that there are no conflicts of interest present.