Evolution of the gastric shunting operation

Recently, the International Federation of Obesity Surgery (IFSO) has recognized gastric bypass surgery as one of the major bariatric / metabolic surgeries. However, the issue of nutritional deficiency after mini-shunting, which leads to repeated surgical interventions for deficient states, remains debatable. Efforts to balance the loss of excess body weight, compensation for concomitant metabolic disorders and nutritional insufficiency make the issue of the “ideal” length of the biopancreatic loop relevant. Therefore, the purpose of the study was to compare the bariatric and metabolic effects of mini-shunting of the stomach depending on the length of the biliary pancreatic loop. The study included 42 patients (24 women (57.1%) and 18 men (42.9%)), aged 24 to 65 years, with a body mass index (BMI) of 40 kg / m2 and above, with a mini-gastric bypass with minimally invasive access. The operation consisted of forming a long gastric reservoir along the small curvature of the stomach with the imposition of a semi-manual anastomosis with a loop of the small intestine 200–250 cm from the ligament of the Trinity. The length of the biopancreatic loop was selected according to the body mass index (200 cm — <45 kg / m2 (23 patients), 250+ cm — ˃45 kg / m2 (15 patients)) and the nature of the concomitant metabolic disorders. Anthropometric, laboratory and instrumental research methods were used. The level of HbA1c and the level of triglycerides were determined. The results were evaluated at 1, 3, 6, 9 and 12 months after surgery. Statistical processing of data was performed using StatPlus 6 Profesional. Postoperative complications were diagnosed in 3 (7.2%) patients. An early complication of Twisted pouch, which required repeated surgery, was observed in 1 (2.4%) patient. Late complications (peptic ulcer of gastroenteroanastomosis and insufficient weight loss) were found in 2 (4.8%) patients. The average percentage of excess body weight loss in the 200 cm and 250 cm group was 70.1 ± 0.8% and 71.8 ± 0.6% (p>0.05), respectively; type 2 diabetes mellitus was diagnosed in 5 (83.3%) and 7 (87.5%) patients, respectively; dyslipidemia compensation was achieved in 3 (50%) and 5 (71.4%) patients, respectively; hypocalcaemia was detected in 1 (12.5%) and 3 (27.3%) patients, respectively; decreased levels of iron were diagnosed in 1 (12.5%) and 2 (18.2%) patients, respectively. Thus, the results obtained indicate that as the length of the loop increases, the metabolic effect increases, but the risk of electrolyte exchange disorders may increase.

In Ukrainian veterinary medicine the study of the eff ectiveness of new complex drugs remains relevant. The eff ect of the vitamin-mineral complex "Alphabet for Animals" on the state of hemocytopoiesis and the microelements metabolism in calves of 1.5‒2.5 months of age were studied. The composition of this drug includes the biologically active substances: vitamins A, D3, E, B1, B3, B5, B6, B12, K3 and essential amino-acids: DL-methionine, L-lysine and arginine. It is used in farm animals and poultry for the normalization of hemocytopoiesis, the prevention and treatment of vitamins and trace elements metabolism’s disorders. In the fi rst week of drug administration, the number of erythrocytes in the experimental animals group has increased signifi cantly (p<0.05) and after its second feeding, the positive eff ect on erythrocytopoiesis in calves has became even greater (p<0.001), compared to the calves in control group. The level of hemoglobin in calves of experimental group also increased signifi cantly from the beginning of the drug to the end of the experiment, whereas in calves of the control group there was a tendency to decrease its level throughout the all experiment. The color index and erythrocyte saturation by hemoglobin (MCH) at the fi rst and second blood samples were signifi cantly decreased (p<0.05) in control calves group, whereas in animals of experimental group there was no signifi cant diff erence between these parameters (p<0.1). The average volume of red blood cells did not diff er between control and test calves during the experiment (p<0.1). Under the drugs infl uence the Ferum blood content in calves of experimental group increased by 24.2 %. In the control calves group, this tendency was not so noticeable (the increase of Ferum serum level at the end of experiment was only +7.8 % (p<0.1), compared to the initial indices). The Zinc metabolism, on the contrary, has not undergone signifi cant changes. The Cuprum serum level in experimental calves group remained always signifi cantly higher than in control animals group. “Alphabet for Animals” has a positive eff ect on hemocytopoiesis in calves due to its complex composition (fat-soluble and water-soluble vitamins, aminoacids) and improves the metabolism of microelements, including Ferum and Cuprum. The infl uence on these processes the vitamins of B group, which are a part of this drug, we consider especially valuable in the conditions of the unformed rumen digestion in young cattle. Key words: vitamin-amino acid complex, erythrocytopoiesis, hypochromia, microcytosis, hemoglobin, color index, hematocrit.

Objective. To study metabolic changes and peculiarities of mineral balance depending on the common loop length while constructing of the simulated model of gastric shunting with one anastomosis during 60 days. Materials and methods. Experimental simulation of gastric minishunting with one anastomosis of various length of bilio-pancreatic loop was constructed on the rats. In 10 rats the anastomosis was formatted on level of half of total length of small intestine (Group I), and also in 10 - a third part of general length of small intestine (Group II). Control Group consisted of 5 rats. The indices of the extra body mass loss and metabolic changes were compared. Results. In the rats of Group I the index of the body mass loss have constituted 16.6% (41.7 gm), and of the Group II -20.6% (53.2 gm). Lowering of indices of mineral and prion metabolism, comparing preoperative values, was observed in both Groups. Dystrophic changes in osseous tissue of vertebral bodies of lumbar vertebral column were noted in animals of both Groups, more pronounced - in Group II. Conclusion. The protein and mineral metabolism disorders may be observed not only in large resection volume, but in exclusion of half and more segment of small bowel from general transit, using gastric shunting, what lacks significant advantages in the extra body mass loss, but leads to more profound metabolic disorders.

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