The prevalence of morbid obesity is on the rise. Surgical intervention for the treatment of morbid obesity has been shown to provide high metabolic efficiency, acquiring a special role in the treatment of type 2 diabetes mellitus. Various surgical procedures are used in treating morbid obesity. These include gastric-bypass surgery and biliopancreatic bypass diversion (BPD), each with various advantages of its own. In recent years, BPD (also referred to as the Scopinaro procedure) has evolved and been modified into the single anastomosis duodeno-ileal (SADI) procedure. Like other types of BPD, the SADI procedure effectively reduces excess body weight and promotes normalisation of carbohydrate and lipid metabolism, leading to a reduced frequency of insulin therapy and use of antidiabetic drugs. The potential benefits of the procedure include reduced operative time and a reduced incidence of internal hernias. Studies have also shown that the SADI procedure results in fewer early and late post-operative complications. Given the effectiveness of the procedure, it is necessary to increase the number and duration of observations made to enable further insight into the long-term efficacy and use of the SADI procedure.

Introduction. Laparoscopic Sleeve Gastrectomy (SG) is a relatively new bariatric operation popularity of which is increasing yearly. However many questions regarding this operation are still unclear. Aim of this study is an assessment of efficacy of SG in the patients of different BMI-groups, evaluation of early and late postoperative complications and possible side effects. Materials and methods. From 2004 г. to August 2014 primary laparoscopic SG in CELT-clinic (Moscow) was performed in 263 patients aged 39,1 ± 10,7 yrs, male/female rate - 55:208, initial weight -113,9± 21,34 kg, mean BMI - 40,1± 6,1 kg/m2. Results. There was no mortality, early complications rate was 4,2%. 92,7 % of pts were follow-uped one year and more after surgery. In the entire group maximal excess weight loss (EWL) was 75,8% at 12 months and 63,7% at 60 months postoperatively. EWL depended on initial BMI. In patients with BMI 35 ( n=39) EWL was 94,1 % at 9 months and remained at level of 90 % to 4 year while in the super-obese patients (BMI50, n=10), maximal mean EWL didn’t exceed 40 % at 2 years. Late complications were: reflux- oesophagitis - 5,7 %, cholelithiasis - 2,7 %, iron-deficiency anemia - 16,3%. 4 (1,5%)of ptsunderwent second-step Duodenal Switch in the late period, but actually more patients need second-step surgery due to insufficient effect of SG. Conclusion. SG is prospective, safe and effective operation and may be considered as stand-alone operation as well as first step of more complex operations. Further evaluation of late (5 years) results is necessary as well as a comparison of results with other bariatric operations.

Searching the optimal options for reoperations in overweight patients has the same lengthy and difficult history as all bariatric surgery. The key issues of this aspect of obesity surgery are inefficiency (inadequate weight reduction or it regain) and the unavoidable complications of conservative methods and the negative effects of primary surgery. Weight regain after bariatric surgery is a multicomponent problem. The main reason for the unsatisfactory results of surgical (and conservative) treatment of obesity in some patients is the nature of obesity – the lifelong chronic recurrent disease. A certain role in the return of excess weight is played by the imperfection of the currently existing surgical procedures for the correction of overweight, as well as the wrong choice of options for surgical interventions and technical errors in their implementation. Increase the number of worldwide operations for obesity and its associated diseases translates the problem of revision bariatric surgery from the category of narrow questions in this field of medicine into a serious problem. The article describes modern approaches to the surgical treatment of re-gaining weight after bariatric operations. It considered options for audit procedures, depending on the previously performed surgery. Original techniques of repeated operations for effective correction of the relapse of overweight are described in article.