BACKGROUND: Bariatric surgery has proven effective as a treatment for the metabolic complications of obesity, including type 2 diabetes mellitus (T2DM). Nowadays it is important to develop a personalized approach for bariatric patients generally, and for those with T2DM.AIM: Development of a scale for preoperative prediction of remission of T2DM in obese patients Russian population undergoing bariatric surgery (sleeve gastrectomy or gastric bypass).MATERIALS AND METHODS: A retrospective multicenter cohort study was conducted. The study included 112 patients (75 women and 37 men), mean age 46.25±9.29 years, mean BMI 48.71±7.66 kg/m². A mathematical analysis of 17 preoperative clinical criteria was carried out to search for independent predictors of T2DM remission.RESULTS: A remission of T2DM was verified in 85 subjects, (75.9%), absence of remission of T2DM — in 27 subjects (24.1%). The most important prognostic factors were T2DM experience, age, HOMA-IR insulin resistance index, HbA_1c, BMI, metformin therapy, SUs, insulin intake, increased levels of liver transaminases, and total cholesterol levels. The relative importance coefficient of each parameter was calculated. A formula has been developed to predict the high or low probability of T2DM remission after bariatric treatment. An online DRAMS (Diabetes Remission After Metabolic Surgery) calculator was proposed based on this formula so it is easy to use in clinical practice.CONCLUSION: An online calculator has been developed to predict the probability of T2DM remission after bariatric surgery. The received data allow us to construct a qualitative “high risk”/“low risk” scale. A number of identified predictors require further study in larger samples of patients.

Background. Bariatric surgery is an effective long-term treatment for obesity and associated metabolic disorders such as type 2 diabetes mellitus (DM), hypertension, dyslipidemia, and sleep apnea. Despite the fact that the safety and effectiveness of bariatric interventions has now been proven, like any other surgical intervention, it’s associated with complications. Objective. To assess the incidence of early complications and 10-day mortality in patients undergoing bariatric surgery in the Russian Federation. Material and methods. Information on the frequency of interventions performed, associated complications and mortality was obtained from the Russian National Bariatric Registry database, containing anonymized data of patients who underwent bariatric intervention in the period from 03/03/2004 to 04/12/2023. The analysis included patients aged 18—70 years who underwent primary surgery. In addition to assessing 10-day mortality rates and the frequency of early postoperative complications, a comparative analysis of the likelihood of developing complications depending on the class of obesity, the patient’s age and the presence of comorbid conditions was carried out. Results. The analysis included 33.627 patients. The 10-day postoperative mortality rate was 0.098%. The rate of early postoperative complications was 1.77% for all types of operations and groups of patients. Bleeding and leakage were the most common: up to 1.2% and 1.5%, respectively, depending on the type of operation. The frequency of their development was statistically significantly influenced by the patient’s age, gender, BMI and the presence of concomitant pathology. Conclusion. Minimal postoperative risks of complications were observed in patients after sleeve gastrectomy. The proportion of bleeding cases in this group did not exceed 0.8%, and the failure of the stapler line did not exceed 0.5%. The 10-day postoperative mortality rate after sleeve gastrectomy was 0.05%.

The article describes the case of a patient with Wernicke encephalopathy, which developed 3 months after the sleeve gastrectomy. An MRI of the brain was performed to verify the diagnosis, which revealed a symmetrical non-uniform increase in the MR signal on T2-WI and Tirm from the medial part of the thalamus, mastoid bodies and gray matter around the aqueduct of Sylvius. Thiamine infusion was promptly initiated as therapy. During treatment, acute neurological symptoms almost regressed, the patient was discharged in a satisfactory condition with preservation of vertical nystagmus under the supervision of specialists at the place of residence. Wernicke–Korsakoff syndrome more often occurs as a complication of alcoholism and arising from thiamine deficiency. However, the fact that this condition also occurs under the influence of other etiopathogenetic factors is often ignored by clinicians. In the management of patients after bariatric interventions, this condition is much more common in malabsorptive operations. However, a combination of certain factors can be described in patients after restrictive types of bariatric surgeries.

Obesity remains one of the global problems of modern healthcare. Complications after bariatric surgery are a serious problem for this group of patients. This article reflects the results of the Second Consensus Conference, held on May 25, 2024 in St. Petersburg and fully devoted to the treatment of complications in bariatric patients. 99 bariatric surgeons participated in the consensus. Consensus was considered achieved when 70% of respondents agreed. The consensus determines the algorithm of actions in the development of complications in a bariatric patient and will allow surgeons who do not have specialized training and experience in the management of bariatric patients to provide effective and timely treatment.

Bariatric surgery represents a widespread approach to treating morbid obesity. The search for biomarkers to identify patients to whom this type of treatment will be most effective is needed. Our aim was to characterize the relationship of levels of lncRNA H19 in plasma and different adipose tissue depots with patients’ response to bariatric surgery. The study includes control subjects, patients with obesity and patients with obesity accompanied by impaired carbohydrate metabolism (ICM). Quantitative analysis of lncRNA H19 levels has been performed using qPCR in plasma and subcutaneous (SAT) and visceral adipose tissue (VAT). Patients with obesity without ICM have higher levels of lncRNA H19 in VAT compared to SAT, and higher levels of lncRNA H19 in SAT compared to SAT of control individuals. One year after the intervention, levels of lncRNA H19 decreased in SAT of patients with obesity without ICM. The preoperative level of lncRNA H19 in VAT demonstrates a positive correlation with excess weight loss and a negative correlation with initial BMI. In conclusion, ICM affects expression of lncRNA H19 in SAT of patients with obesity. The preoperative level of lncRNA H19 in VAT can be used to predict excess weight loss in patients with obesity after bariatric surgery.

Bariatric surgery remains the most effective method of treating morbid obesity, however, modern approaches require the integration of pharmacotherapy and multidisciplinary support to achieve sustainable results. The purpose of this literature review was to analyze current trends in bariatric surgery, evaluate the effectiveness of various surgical interventions, as well as the role of pharmacotherapy and standardization of protocols in improving the quality of treatment. A review of randomized clinical trials, meta-analyses, and registry data on the outcomes of laparoscopic longitudinal gastric resection (PRG), the use of GLP-1 agonists and double GIP/GLP-1 agonists, multidisciplinary patient management, and the implementation of ERAS protocols has been performed. Longitudinal gastric resection provides 60–70 % of excess body weight loss (EWL) within 5–7 years and remission of type 2 diabetes in 50–60 % of cases, comparable with the results of gastric bypass surgery. For patients with superobesity, this technique remains highly effective and safe. A multidisciplinary approach helps to reduce the risk of relapse and increase the effectiveness of therapy. Pharmacotherapy using semaglutide and tirzepatide is effective both before and after surgery, reducing the frequency of weight loss. The standardization of treatment protocols has reduced the incidence of complications to 1.06 % and shortened the duration of hospitalization. Laparoscopic longitudinal gastric resection remains the basic method of bariatric surgery, the effectiveness of which is significantly increased when combined with pharmacotherapy and comprehensive multidisciplinary management. The use of digital technologies and the standardization of treatment protocols contribute to increased safety and improved longterm treatment outcomes for patients with morbid obesity.