asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-057asurgery-595Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEАнализ эффективности и безопасности применения транексамовой кислоты в профилактике кровотечений после бариатрических операций: ретроспективное исследованиеAnalysis of the effectiveness and safety of tranexamic acid in the prevention of bleeding after bariatric surgeries: A retrospective studyhttps://orcid.org/0000-0002-8903-1174ХитарьянА. Г.KhitaryanA. G.

Хитарьян Александр Георгиевич, д.м.н., профессор, заслуженный врач РФ, заведующий кафедрой хирургических болезней №3, 344022, Ростов-на-Дону, пер. Нахичеванский, д. 29;

заведующий хирургическим отделением, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Alexander G. Khitaryan, Dr. Sci. (Med.), Professor, Honoured Doctor of the Russian Federation, Head of the Department of Surgical Diseases No. 3, 29, Nakhichevan Lane, Rostov-on-Don, 344022;

Head of the Surgical Department, 92A, Varfolomeev St., Rostov-on-Don, 344011

khitaryan@gmail.comhttps://orcid.org/0000-0001-7787-4919МежунцА. В.MezhuntsA. V.

Межунц Арут Ваграмович, к.м.н., ассистент кафедры хирургических болезней №3,  344022, Ростов-на-Дону, пер. Нахичеванский, д. 29;

врач-хирург, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Arut V. Mezhunts, Cand. Sci. (Med.), Assistant of the Department of Surgical Diseases No. 3,  29, Nakhichevan Lane, Rostov-on-Don, 344022;

Bariatric Surgeon of the Surgical Department, 92A, Varfolomeev St., Rostov-on-Don, 344011

arut.mezhunts@mail.ruhttps://orcid.org/0000-0002-1829-3345МельниковД. А.MelnikovD. A.

Мельников Денис Андреевич, к.м.н., ассистент кафедры хирургических болезней №3,  344022, Ростов-на-Дону, пер. Нахичеванский, д. 29;

врач-хирург, 344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Denis A. Melnikov, Cand. Sci. (Med.), Assistant of the Department of Surgical Diseases No. 3, 29, Nakhichevan Lane, Rostov-on-Don, 344022;

Bariatric Surgeon of the Surgical Department, 92A, Varfolomeev St., Rostov-on-Don, 344011

d.melnikov@clcorp.ruhttps://orcid.org/0000-0001-5632-1469ОплимахК. С.OplimakhK. S.

Оплимах Ксения Сергеевна, аспирант кафедры хирургических болезней №3,

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

Kseniya S. Oplimakh, Postgraduate Student of the Department of Surgical Diseases No. 3,

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

net.2035@mail.ruhttps://orcid.org/0009-0003-5292-9612БалинаК. Н.BalinaK. N.

Балина Кира Николаевна, студент,

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

Kira N. Balina, Student, 

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

kira_balina@mail.ruhttps://orcid.org/0009-0001-9672-2088КиртанасоваЕ. Я.KirtanasovaE. Ya.

Киртанасова Елена Яковлевна, студент,

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

Elena Ya. Kirtanasova, Student,

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

elena.kirtanasova@yandex.ruhttps://orcid.org/0009-0007-1335-7016ДюжиковА. И.DyuzhikovA. I.

Дюжиков Александр Игоревич, студент,

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

Alexander I. Dyuzhikov, Student,

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

a.duyzhikov@icloud.comРостовский государственный медицинский университет; Клиническая больница «РЖД-Медицина»РоссияRostov State Medical University; Clinical Hospital “RZD-Medicine”Russian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation202525112025222217225Copyright © Хитарьян А.Г., Межунц А.В., Мельников Д.А., Оплимах К.С., Балина К.Н., Киртанасова Е.Я., Дюжиков А.И., 20252025Хитарьян А.Г., Межунц А.В., Мельников Д.А., Оплимах К.С., Балина К.Н., Киртанасова Е.Я., Дюжиков А.И.Khitaryan A.G., Mezhunts A.V., Melnikov D.A., Oplimakh K.S., Balina K.N., Kirtanasova E.Y., Dyuzhikov A.I.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/595Введение

Введение. Бариатрическая хирургия является безопасной методикой снижения веса, при условии, что она выполняется в сертифицированных центрах хирургами, прошедшими кривую обучения. Тем не менее по-прежнему существует риск развития серьезных осложнений после бариатрических операций. Согласно большинству исследований, большое кровотечение является основной причиной повышенной послеоперационной заболеваемости и увеличения продолжительности пребывания в стационаре.

Цель

Цель. Оценить эффективность и профиль безопасности транексамовой кислоты (ТК) для профилактики кровотечений после бариатрических операций.

Материалы и методы

Материалы и методы. Проанализированы медицинские карты всех пациентов, которым были выполнены первичные бариатрические операции по стандартным протоколам. Всего с 2016 по 2024 г. было выполнено 2 524 бариатрических вмешательства. С 2016 по 2023 г. было проведено 1 983 операции – группа пациентов, которым ТК интраоперационно рутинно не вводилась. С января по декабрь 2024 г. было выполнено 541 оперативное вмешательство – группа пациентов, у которых операция заканчивалась внутривенным введением 1 000 мг ТК.

Результаты

Результаты. В послеоперационном периоде в группе пациентов, где ТК интраоперационно не применялась, было зарегистрировано 32 кровотечения (1,6%), тогда как в группе с применением ТК не выявлено ни одного случая (0%) больших кровотечений (p = 0,0279). Интралюминальное кровотечение было зарегистрировано в 3 случаях, и все они были выявлены при гастрошунтировании по Ру.

Выводы

Выводы. ТК является эффективным дополнением к тщательной хирургической технике выполнения бариатрических операций, способствуя снижению риска кровотечения и улучшению результатов благодаря своей доступности, экономической эффективности, быстрому началу действия и системному эффекту.

Introduction

Introduction. Bariatric surgery is a safe method of weight loss when performed in certified centers by surgeons who have completed the learning curve. However, there is still a risk of serious complications of bariatric operations. According to most studies, major bleeding is the main cause of increased postoperative morbidity and prolonged hospital stay.

Aim

Aim. To evaluate the effectiveness and safety profile of tranexamic acid (TXA) in the prevention of bleeding after bariatric surgeries.

Materials and methods

Materials and methods. We analyzed medical records of all patients who underwent primary bariatric surgeries according to standard protocols. A total of 2,524 bariatric interventions were performed from 2016 to 2024. From 2016 to 2023, 1,983 operations were performed – a group of patients who did not routinely receive TXA intraoperatively. From January to December 2024, 541 surgical interventions were performed – a group of patients whose surgery ended with intravenous administration of 1,000 mg of TXA.

Results

Results. In the postoperative period, 32 cases of bleeding (1.6%) were registered in the group of patients where TXA was not used intraoperatively, whereas no no cases (0%) of major bleeding were observed in the group where TXA was used (0%; p = 0.0279). Intraluminal bleeding was recorded in 3 cases, all 3 cases were identified during Roux-en-Y gastric bypass.

Conclusions

Conclusions. TXA is an effective complement to careful surgical technique for bariatric operations to reduce the risk of bleeding and improve outcomes due to its availability, cost-effectiveness, rapid onset of action, and systemic effect.

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