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Background: Roux-en-Y gastric bypass is the main type of bariatric surgery. The most formidable and severe complication in morbid obesity patients after gastric bypass is gastrojejunostomy leak. Aim: to study the possibilities of improving treatment outcomes of obese patients during gastrojejunostomy leak after gastric bypass surgery using new minimally invasive methods. Methods: This retrospective cohort descriptive study included all patients with gastrojejunostomy leak after gastric bypass treated in the Department of Surgery of the Federal State Budgetary Institution Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia in 20192022. In total, 445 gastric bypasses were performed during this period, and seven patients (1.6%) developed HEA failure in the postoperative period. Results: The results of treatment of gastroenteroanastomotic leaks during gastric bypass in patients with morbid obesity are presented. The early diagnosis of gastroenteroanastomosis failure in this category of patients was difficult. All doubts in the diagnosis of anastomotic failure should be completed by revision laparoscopy with intraoperative esophagogastroscopy. Minimally invasive techniques (surgical, endoscopic), drug therapy, and adequate nutritional support are crucial for managing patients with anastomotic leaks. Conclusion: The use of an endoscopic intraluminal vacuum aspiration system in the treatment of gastroenteroanastomotic insufficiency avoids the spread of inflammation in the abdominal cavity, accelerates the reparative process in the area of insufficiency, and, in most cases, avoids programmed sanitation, significantly improving the treatment results.

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Background: The need for simultaneous cholecystectomy for asymptomatic cholelithiasis in patients undergoing bariatric intervention has not been proven. The experience of managing patients with obesity and concomitant disease cholelithiasis is presented. Aim: to determine the indications for simultaneous cholecystectomy and bariatric surgery in the combination of morbid obesity and a asymptomatic cholelithiasis. Methods: The results of observation of 37 patients with initially asymptomatic cholelithiasis were analyzed: 27 patients underwent bariatric surgery and simultaneous cholecystectomy, and 10 patients underwent only bariatric surgery. The immediate and long-term results of the treatment, the quality of life of patients and the cost of the treatment were assessed. Results: During 12 months of the follow-up, none of the patients who underwent simultaneous cholecystectomy developed any complications. Of the 10 patients in the observation group, 3 were operated on. Two patients underwent laparoscopic cholecystectomy for acute cholecystitis and one patient was operated on for choledocholithiasis with obstructive jaundice. The greatest improvement in the quality of life was observed in the gastric bypass group with simultaneous cholecystectomy. The treatment cost per patient was lower in that group, too. Conclusion: In the presence of asymptomatic cholelithiasis in a patient with morbid obesity, bariatric intervention and simultaneous cholecystectomy prevents the development of complications of cholelithiasis and thereby potentially improves the quality of life and reduces the cost of medical care.