The article presents clinical case surgical treatment of obesity in the patient with Prader-Willy-Labhart syndrome (PWS). The patient had characteristic phenotypic features of the disease: low growth, narrow temporal part of the skull, dolichocephaly, acromicria. There was a delay in psychomotor development, hypogonadism. Excess body weight was noted from three years old with a gradual progression of obesity. Now patient is 23 and her weight is 159 kg with an increase of 150 cm (BMI 70.7 kg/m2). The co-morbidities were represented by arterial hypertension, type 2 diabetes and bronchial asthma. The indication for surgical treatment was the morbid (III degree) obesity by the Prader-Willy-Labhart syndrome, complicated by the development of diseases associated with overweight and non-medicated therapy. After a long (three-week) preoperative preparation aimed at correcting the manifestations of bronchial asthma and obesity-related diseases, laparoscopic sleeve gastrectomy was performed. The choice of the procedure of operation was determined by its pathogenetic reasonability (resection the most part of the stomach, which is producing ghrelin), and severe comorbid background (which is limiting the time of surgery) and severe hyperphagia (which is requiring a procedure with a predominantly restrictive mechanism of action). After operation period flowed without complications. The patient noted decrease of the appetite and the relief keeping nutrition's regime. A year after laparoscopic sleeve gastrectomy the patient achieved reduction of 59 kg body mass and remission of co-morbidities. A positive effect in metabolic profile allows us to consider laparoscopic sleeve gastrectomy as an effective method for treating patients with Prader-Willy-Labhart syndrome.

Obesity is considered now as a chronic relapsing lifelong disease, with a tendency to progression. According to the WHO, it present about 60% of the population of economically developed countries is overweight, 25-30% – is obesity. Russia is in fifth place in the world in the prevalence of obesity and overweight, being second only to the United States, Mexico, Hungary and Scotland. According to the Research Institute of Nutrition in the North-West region of the Russian Federation, 29.7% of women and 18.5% of men are overweight. Associated with obesity diseases include atherosclerosis, type 2 diabetes, hypertension, coronary heart disease, hormonal disorders, some cancers, etc. In proportion to the number of obese people increases and the incidence of pathological conditions associated with overweight. The vast majority of 95% of obese people die from causes directly related to overweight. The life expectancy of patients with overweight is reduced by 10-20 years, depending on the age of development and severity of obesity. The effectiveness of the conservative methods of correction associated with overweight in the arsenal of medicine today is low due to the complexity of the impact on their main cause – overweight. The article presents modern ideas about the mechanisms of action, hormonal and metabolic effects of the main types of bariatric operations. High long-term efficacy of surgical treatment of obesity-associated dis-orders of lipid and carbohydrate metabolism, arterial hypertension has been shown.

The celiac trunk compression syndrome and the gastroesophageal reflux disease are quite common pathological conditions in the population of economically developed countries. The frequency of combining and the semiotics these illness has not been studied. There are no approaches to the diagnosis and treatment of gastroesophageal reflux disease, which developed on background of chronic ischemia of the abdominal cavity organs due to occlusion of the celiac trunk. Few papers devoted to this subject are limited to a small series of clinical observations without a detailed understanding of the problem and finding answers to these questions. The article presents an analysis of the clinical manifestations and results of instrumental diagnosis in 84 patients with a combination of the celiac trunk compression syndrome and the gastroesophageal reflux disease treated from 2011 to 2015 years. In this work the main symptoms characteristic of both diseases combination have been identified. A detailed description and characteristic of the basic methods of diagnostics are given. A practical algorithm for the detection of gastroesophageal reflux disease links with the celiac trunk compression syndrome is presented and justified in approach.

The article discusses modern methods of treatment of morbid obesity and associated diseases. It is known that obesity leads to disability in people, including young people, due to the frequent development of severe comorbid diseases. According to current clinical guidelines, the main goals of treating obese patients are: weight loss, achieving good metabolic control, and improving the course of diseases associated with obesity. A small selection of drugs for the treatment of obesity, the need for strict adherence to indications and contraindications to their appointment, significantly limits the possibilities of drug therapy for morbid obesity. With morbid obesity, the effectiveness of conservative treatment is only 510%. Up to 60% of patients cannot maintain the result of weight loss within 5 years of observation. Long-term use of bariatric surgeries, the purpose of which was initially to reduce body weight in patients with morbid obesity, showed certain possibilities of surgery in compensating for a number of diseases associated with obesity. Therefore, at present, the concept of bariatric surgery is not only to reduce the patients weight, but also to achieve beneficial metabolic effects (normalization of glycemia, lipid metabolism). In this regard, modern bariatric interventions are united by the term metabolic surgery. It has been proven that compensation of non-insulin-dependent diabetes mellitus after bariatric interventions is observed in 4295% of patients, depending on the type of surgery, duration of non-insulin-dependent diabetes mellitus and basal C-peptide level. As a result of many years of research, bariatric surgery has allowed for the first time to formulate the term remission of non-insulin dependent diabetes mellitus.