Strategy for surgical treatment of patients with morbid obesity

Introduction. The approach for choosing the type of bariatric intervention remains a controversial, as well as the issue of insufficient weight loss and postoperative weight regain. Aim. Development and outcomes of a personalized algorithm for bariatric procedure selection and postoperative management in morbid obesity. Development and evaluation of the effectiveness of a differentiated approach to the choice of bariatric intervention and the intensity of postoperative monitoring in patients with morbid obesity. Methods. The study was conducted in two stages. First, treatment outcomes were evaluated in a retrospect comparison group of 502 patients who underwent various bariatric procedures (sleeve gastrectomy, Roux-en-Y gastric bypass, mini gastric bypass) without a standardized selection protocol. The results gained from this evaluation were used to develop a structured selection algorithm, which was then validated in a prospective main cohort of 380 patients. Results. By implementing a bariatric surgery selection algorithm that considers mental disorders, factors associated with unsatisfactory metabolic surgery outcomes, and the characteristics of diabetes and gastroesophageal reflux disease, we achieved an improvement in %EWL one year after surgery (from 58,7 to 65,6 %), with a further increase in the difference after 5 years due to lower weight regain. Better results were achieved in the study group with respect to concomitant carbohydrate metabolism disorders and gastroesophageal reflux disease. Conclusion. The developed algorithm for selecting bariatric surgery and postoperative follow-up intensity-based on the patient's psychological and comorbidity profile is recommended for clinical practice.