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Laparoscopic sleeve gastrectomy (LSG) is an effective method of treating obesity complicated by type 2 diabetes mellitus (T2DM). The performance of this metabolic surgical intervention involves removal fundus of the stomach, which in turn leads to an effect on the eating behavior of patients in the form of a decrease in appetite and loss of excess body weight with a parallel effect on the compensation of T2DM in the postoperative period, regardless of the loss of body weight. At present, mechanisms of T2DM compensation after LSG have not yet been clearly defined. The aim of our study was to study the effect of LSG on the dynamics of changes in the blood plasma ghrelin levels in patients with T2DM associated with obesity. The plasma ghrelin levels were assessed in the fasted state, 15, 30, 60, and 90 min after a standard breakfast carbohydrate preload, which included 125 ml of Nutricia Nutridrink, a balanced high-energy protein. The examination was carried out before the operation, on the 4th postoperative day and 3 months after the operation. 7 patients were diagnosed with T2DM for the first time, 3 had a history of diabetes for 2 years, one patient had a history of 3.5 years, and another had a history of 10 years. The average content of glycated hemoglobin before the operation was 7.7 ± 1.6%, 3 months after LSG - 5.9 ± 0.4%. The fasting ghrelin concentration before LSG performing was 6.8 ± 1.1 ng/ml, on the 4th postoperative day - 4.6 ± 0.7 ng/ml, and 3 months after the operation - 4.4 ± 0.6 ng/ml (P = 0.001 in comparison with preoperative indicators). The peak insulin concentration was noted 30 min after the carbohydrate preload 3 months after the operation and was 175.1 ± 9.9 μU/ml, and its fasting levels in the postoperative period reached a statistically significant difference compared to the preoperative values (30 ± 11.3 μU/ml before surgery and 25.3 ± 10.9 μU/ml 3 months after LSG). Thus, LSG leads to an early and significant suppression of fasting ghrelin secretion in patients with obesity-associated T2DM and likely to restore insulin secretion and/or reduce insulin resistance. Rapid postoperative improvement of carbohydrate metabolism components indicates the importance of the early reduction of ghrelin secretion in combination with the incretin effect of LSG in the implementation of the mechanisms of early compensation of T2DM and explains the metabolic activity of this operation and the significant role of the stomach in the regulation of glucose metabolism. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate gastric decompression in patients after laparoscopy sleeve gastrectomy (LSG). We performed a retrospective analysis of the treatment of 64 patients with morbid obesity who underwent laparoscopy sleeve gastrectomy. 25 patients who have undergo LSG with a nasogastric tube placement composed group 1; in the other 39 patients, no nasogastric tube was placed (group 2). No statistical differences were observed between groups 1 and 2 regarding gender distribution, age, weight, body mass index, and excessive weight. Intraoperative blood loss (184 ± 85.1 vs. 164.1 ± 58.4 ml, respectively) and operative time (132.1 ± 24.5 vs. 120.8 ± 23.6 min, respectively) were comparable between the groups. A staple line leak once occurred on the 5th postoperative day in group 1 and no leak was observed in group 2 patients. The complication rate, mainly, tube-related otolaryngological complications, was higher in group 1. Post-operative hospital stay was significantly longer in group 1 vs. group 2 patients (8.9 ± 2.1 vs. 6.3 ± 1.7 days, respectively; t = 5.89). We conclude that routine placement of a nasogastric tube in LSG patients is not useful in reducing leak incidence. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the safety and efficacy of a 2-week ultra-low-calorie, high-protein, low-carbohydrate diet to reduce body weight, left liver volume, and correct biochemical parameters in patients with planned bariatric surgery. A retrospective analysis of the treatment of 32 patients (23 men and 9 women) with morbid obesity who were in the surgical department from 2018 to 2021. They underwent preoperative preparation followed by laparoscopic hose resection of the stomach. The mean age of patients was 43.8 ± 11.7 years, body weight - 175.5 kg (167.5-193.8 kg), body mass index (BMI) - 58.8 ± 10.3 kg/m2, area left lobe of the liver - 80.9 ± 18 cm2, the average thickness of subcutaneous tissue - 36.5 (25-40) mm, the average level of ALT - 45.8 (41.4 - 61.8) μmol/l, AST - 42, 4 (34.8 - 52.5) μmol/l, total cholesterol - 6.09 ± 0.79 mmol/l, HDL-cholesterol - 0.93 ± 0.22 mmol/l, LDL-cholesterol - 3.75 ± 0.99 mmol/l and triglycerides - 2.09 ± 0.66 mmol/l. 2 weeks after the start of the diet, the percentage of weight loss (% BMD) reached 9.9 ± 2.7% (5.6-16.5%), body weight - 164.5 kg (153.8-184.3 kg) and the average value of BMI - 55.4 ± 9.7 kg/m2, the area of the left lobe of the liver - 69.6 ± 17.5 cm2, the average thickness of subcutaneous tissue - 31.5 (22-37) mm, the average level of ALT - 42.8 (28.8 - 49.2) μmol/l, AST - 29.3 (22.9 - 37.7) μmol/l, total cholesterol - 5.24 ± 0.83 mmol/l, HDL -HS - 1.19 ± 0.2 mmol/l, LDL-cholesterol - 4.57 ± 0.87 mmol/l and triglycerides - 1.65 ± 0.78 mmol/l. Thus, prescribing an ultra-low-calorie, high-protein, low-carbohydrate diet is a safe and effective way to reduce excess weight, reduce anterior abdominal wall thickness, reduce left liver size, and correct biochemical parameters in high-risk patients before bariatric surgery. [ABSTRACT FROM AUTHOR]

Obesity is an established risk factor for cardiovascular diseases (CVD) such as hypertension (HD), coronary artery disease (CAD), heart failure (HF), arrhythmias and venous thromboembolism. Lifestyle modifications to reduce weight have been shown to be successful in the short term, however their long-term results are still equivocal likely due to modest weight reduction and high recurrence rates. Bariatric surgery has been recognized as the most effective strategy in achieving substantial sustained weight loss, and can prevent the development or reverse CVD, metabolic syndrome, diabetes mellitus, obstructive sleep apnea syndrome, cancer, and COVID-associated complications. Bariatric surgery results in rapid weight loss over several months that lasts for at least 12-18 months. The surgery lowers all-cause mortality risks, risks of myocardial infarction and stroke. Furthermore, bariatric surgery contributes to the reduction of urgent hospitalizations for heart failure, coronary artery disease, and hypertension. The article shows modern view on the impact of bariatric surgery on the pathogenesis of the CVD in patients with obesity, indications and contraindications of the surgery, tactics of management of patients with existing cardiovascular pathology before the bariatric surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (LSG) proved to be a valuable procedure for treating obesity complicated by type 2 diabetes mellitus (T2DM). The mechanism of T2DM resolution after LSG is not yet clearly defined. The objective of the study was to investigate the effect of LSG on the secretion of GLP-1 in patients with T2DM associated with obesity. Plasma GLP-1 levels were evaluated by starvation and 15, 30, 60 and 90 min after the standard carbohydrate preload for breakfast, which included 125 ml of balanced high energy Nutricia Nutridrink Protein. Evaluations were made on the eve of the procedure, for 4 days and 3 months after the operation. In 7 patients with T2DM were diagnosed for the first time, in 3 patients with diabetic history 2 years, in 1 patient - 3.5 years and in 1 patient - 10 years. Mean glycated hemoglobin before surgery was 7.7 ± 1.6%, 3 months after LSG - 5.9 ± 0.4%. The concentration of GLP-1 in 30 minutes before surgery was 6.7 ± 0.9 ng/ml. On the 4th day after LSG, the mean level of GLP-1 was 9.6 ± 0.2 ng/ml, which statistically differed from its level in the pre-operative period, and after 3 months the mean level of GLP-1 statistically increased to 13.7 ± 0.3 ng/ml. Thus LSG leads to an early and significant increase in post-prandial secretion GLP-1 in T2DM patients associated with obesity. The rapid postoperative improvement in signs of carbohydrate metabolism indicates the importance of the incretin effect LSG in the implementation of early compensation mechanisms for T2DM and explains the metabolic activity of this operation. [ABSTRACT FROM AUTHOR]