Comparison of the dynamics of metabolic effects of performing different methods of bariatric interventions on the course of reflux disease in patients with morbid obesity in the early and late postoperative period.

71 patients with morbid obesity, aged 21 to 65 years, were examined. Among the patients, there were 36 (50.7%) women and 35 (49.3%) men. The stratification of patients was carried out depending on the method of bariatric intervention: Group I - 30 (42.3%) patients: biliopancreatic bypass in the Hess-Marceau modification; Group II - 41 (57.7%) patients - sleeve gastrectomy. According to the body mass index, the patients were distributed almost evenly: Group 1 - 10 (33% - obesity grade 2) and 20 (67% - obesity grade 3), Group 2 - 14 (34.1% - obesity grade 2) and 27 (65.9% - obesity grade 3). Upper endoscopy was performed on all patients in the preoperative period: in group I, 12 (40%) patients were diagnosed with reflux esophagitis (A, B and C according to the LA classification); in group II, 19 (46%) patients (also mild and moderate GERD). Patients were treated for 2 weeks, endoscopic control was not performed before surgery.

In the postoperative period, not only the dynamics of changes in body weight of patients, but also the course of reflux disease were analyzed. Analysis of the dynamics of indicators within 3 years after bariatric interventions, both in general and in terms of different techniques and gender of patients, proved the fact of intensive reduction of body weight and, accordingly, BMI, within 12 months after BPS and in the period of 3-6 months in patients after sleeve gastrectomy. Achievement of statistical comparability of BMI indicators in both groups (p>0.05) occurred already after 3-6 months in women, and after 1.5 years after surgery in men. Postoperatively, upper endoscopy was performed 3 years later: reflux disease was detected in 9 (30%) patients in group I and in 8 (19.5%) patients in group II (table 1).

Distribution of patients with reflux disease after bariatric surgery

Bariatric surgical methods of treating obesity can be considered as a treatment for GERD: in patients who underwent biliopancreatic bypass in the Hess-Marceau, a decrease in the number of GERD episodes was observed in the postoperative period from 12 (40%) to 9 (30%) cases; after sleeve gastrectomy from 19 (46%) to 8 (19.5%). Better results are observed after sleeve gastrectomy, which also correlates with a decrease in BMI at an earlier stage after this intervention.