Метаболическая хирургия: от истории к реальным достижениям

Бариатрическая и метаболическая хирургия зародилась в середине XX века и выросла из экспериментальных хирургических методов направленных на снижение веса. В процессе исследования и совершенствования хирургических методик происходило выделение более физиологичных операций, характеризующихся меньшим количеством осложнений, формировались концепции хирургического лечения атерогенных дислипидемий и предупреждения развития атеросклероза, снижения риска развития метаболических или сердечно-сосудистых осложнений тяжелого ожирения, представления о метаболической операции как о средстве для достижения гликемического контроля. В статье приведена актуальная информация о современных метаболических операциях, таких как бандажирование желудка, продольная резекция желудка, желудочное шунтирование или гастрошунтирование по Ру (Roux-en-Y gastricbypass), билиопанкреатическое шунтирование. Представлены данные об эффективности метаболических операций в лечении ожирения и сахарного диабета 2 типа за счет создания механического ограничения для поступления пищи в верхние отделы желудочно-кишечного тракта, уменьшения чувства голода за счет снижения уровня гормона грелина, уменьшения количества висцерального жира, формирования синдрома мальабсорбции, инкретиновый эффект, гипотезы передней (Foregut) и задней (Hindgut) кишки. Также обсуждается влияние бариатрических операций на сердечно-сосудистую систему и неалкогольную жировую болезнь печени.

Бариатрическая хирургия, метаболическая хирургия, бандажирование желудка, продольная резекция желудка, желудочное шунтирование, билиопанкреатическое шунтирование

1. V Henrikson. Can Small Bowel Resection Be Defended as Therapy for Obesity? Obesity Surgery. February 1994, Volume 4, Issue 1, pp 54-54.

2. Kremen A.J., Linner J. H., Nelson C. H. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954; 140:439-448.

3. Payne J.H., DeWind L.T., Commons R. R. Metabolic observations in patients with jejunocolic shunts. Am J Surg. 1963; 106:273-289.

4. Lewis L.A., Turnbull R. B., Page I. H. Effects of jejunocolic shunt on obesity, serum lipoproteins, lipids, and electrolytes. Arch Intern Med. 1966; 117:4-16.

5. Mir-Madjlessi S.H., Mackenzie A. H., Winkelman E. I. Articular complications in obese patients after jejunocolic bypass. Cleve Clin Q. 1974; 41:119-133.

6. Pi-Sunyer F. Jejunoileal bypass surgery for obesity. Am J Clin Nutr. 1976; 29:409-416.

7. Scopinaro N. The IFSO and obesity surgery throughout the world.International Federation for the Surgery of Obesity. Obes Surg. 1998 Feb;8(1):3-8.

8. Buchwald H. Metabolic Surgery. In: Lucchese M, Scopinaro N. editors. Minimally Invasive Bariatric and Metabolic Surgery. New York: Springer, 1978, pp. 69-79.

9. Fobi M. A. Surgical treatment of obesity: a review. J Natl Med Assoc. 2004; 96:61-75.

10. Deitel M. Overview of operations for morbid obesity. World J Surg. 1998; 22:913-918.

11. Alden J. F. Gastric and jejunoileal bypass. A comparison in the treatment of morbid obesity. Arch Surg. 1977 Jul;112(7):799-806.

12. Scopinaro N., Gianetta E., Civalleri D., et al. Biliopancreatic bypass for obesity. Part II. Initial experience in man. Br J Surg. 1979; 66:618-620.

13. Scopinaro N. Thirty-five years of biliopancreatic diversion: notes on gastrointestinal physiology to complete the published information useful for a better understanding and clinical use of the operation. Obes Surg. 2011; 22:427-432.

14. Mason E. E. Vertical banded gastroplasty for morbid obesity. Arch Surg. 1982; 117:701.

15. Deitel M., Shikora S. A. The development of the surgical treatment of morbid obesity. J Am Coll Nutr. 2002;21(5):365-371. doi:10.1080/07315724.2002.10719237

16. Buchwald H., Avidor Y., Braunwald E., et al. Bariatric surgery: a systematic review and meta-analysis. Jama J Am Med Assoc. 2004;292(14):1724-37.

17. Cummings D.E., Cohen R. V. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014;2:175-81.

18. Cohen R., Caravatto P. P., Petry T. Surgery for Diabetes. Curr Surg Rep. 2013;1:160-6.

19. Sjöström L., Peltonen M., Jacobson P., et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56-65.

20. Cummings D.E., Flum D. R. Gastrointestinal surgery as a treatment for diabetes. JAMA. 2008;299:341-3.

21. Nassour I., Almandoz J. P., Adams-Huet B., Kukreja S., Puzziferri N. Metabolic syndrome remission after Roux-en-Y gastric bypass or sleeve gastrectomy. Diabetes Metab Syndr Obes. 2017 Sep 20;10:393-402. doi: 10.2147 /DMSO.S142731

22. Thaler J.P., Cummings D. E. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150:2518-25.

23. Madsbad S., Dirksen C., Holst J. J. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol. 2014;2:152-64.

24. Salehi M., Woods S. C., D’Alessio D. A. Gastric bypass alters both glucose-dependent and glucose-independent regulation of islet hormone secretion. Obesity (Silver Spring). 2015;23:2046-52.

25. Tremaroli V., Karlsson F., Werling M., et al. Roux-en-Y gastric bypass and vertical banded gastroplasty induce long-term changes on the human gut microbiome contributing to fat mass regulation. Cell Metab. 2015;22:228-38.

26. Dirksen C., Jørgensen N. B., Bojsen-Møller K.N., et al. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass. Diabetologia. 2012;55:1890-901.

27. Breen D.M., Rasmussen B. A., Kokorovic A., et al. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med. 2012;18:950-5.

28. Ryan K.K., Tremaroli V., Clemmensen C., et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature. 2014;509:183-8.

29. Liou A.P., Paziuk M., Luevano Jr J. M., et al. Conserved shifts in the gutmicrobiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5:178ra41.

30. Saeidi N., Meoli L., Nestoridi E., et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341:406-10.

31. Miras A.D., le Roux C. W. Mechanisms underlying weight loss after bariatric surgery. Nat. Rev. Gastroenterol. Hepatol. 2013;10:575-584. doi: 10.1038/nrgastro.2013.119.

32. Gualillo O., Lago F., Gómez-Reino J., Casanueva F. F., Dieguez C. Ghrelin, a widespread hormone: insights into molecular and cellular regulation of its expression and mechanism of action. FEBS Letters. 2003;552(2-3):105-109.

33. Wajnrajch M.P., Ten I. S., Gertner J. M., Leibel R. L. Genomic organization of the human ghrelin gene. Journal of Endocrine Genetics. 2000;1(4):231-233.

34. Toshinai K., Yamaguchi H., Sun Y., et al. Des-acyl ghrelin induces food intake by a mechanism independent of the growth hormone secretagogue receptor. Endocrinology. 2006;147(5):2306-2314.

35. English P.J., Ghatei M. A., Malik I. A., et al. Food fails to suppress ghrelin levels in obese humans. J. Clin. Endocrinol. Metab. 2002; 87: 2984-95

36. Horvath T.L., Diano S., Sotonnyi P., et al. Minireview: Ghrelin and the regulation of energy balance - a hypothalamic perspective. Endocrinology. 2001; 142:4163-4169.

37. Yousseif A., Emmanuel J., Karra E., et al. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans. Obes Surg. 2014 Feb;24(2):241-52.

38. Ochner C.N., Gibson C., Shanik M. Changes in neurohormonal gut peptides following bariatric surgery.Int J Obes. 2011;35(2):153-66.

39. Lee W.J., Chen C. Y., Chong K. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):683-90.

40. Pories W.J., Swanson M. S., MacDonald K.G., et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995 Sep; 222(3):339-50; discussion 350-2.

41. Scopinaro N., Adami G. F., Marinari G. M., et al. Biliopancreatic diversion. World J Surg. 1998;22(9):936-946. doi:10.1007/s002689900497

42. Rubino F., Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002 Nov;236(5):554-9.

43. Rubino F., Gagner M., Gentileschi P., et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004 Aug;240(2):236-42.

44. Rubino F., Forgione A., Cummings D. E., et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006 Nov;244(5):741-9.

45. Yamamoto H., Kaida S., Yamaguchi T., Murata S., Tani M., Tani T. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery. Surg Today. 2016 Mar;46(3):268-74.

46. Strader A.D., Vahl T. P., Jandacek R. J., Woods S. C., D’Alessio D. A., Seeley R. J. Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005 Feb;288(2): E447-53.

47. Ochner C.N., Gibson C., Shanik M. Changes in neurohormonal gut peptides following bariatric surgery.Int J Obes. 2011;35(2):153-66.

48. Lee W.J., Chen C. Y., Chong K. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):683-90.

49. Kohli R., Setchell K. D., Kirby M., et al. A surgical model in male obese rats uncovers protective effects of bile acids post-bariatric surgery. Endocrinology. 2013 Jul;154(7):2341-51.

50. Zhang X., Liu T., Wang Y., Zhong M., Zhang G., Liu S., Wu T., Rayner C. K., Hu S.Comparative Effects of Bile Diversion and Duodenal-Jejunal Bypass on Glucose and Lipid Metabolism in Male Diabetic Rats. Obes Surg. 2016 Jul;26(7):1565-75.

51. Jahansouz C., Xu H., Hertzel A. V. Bile acids increase independently from hypocaloric restriction after bariatric surgery. Ann Surg. 2016;264(6):1022-8.

52. Khan F.H., Shaw L., Zhang W. Fibroblast growth factor 21 correlates with weight loss after vertical sleeve gastrectomy in adolescents. Obesity (Silver Spring). 2016;24(11):2377-83

53. Ryan K.K., Tremaroli V., Clemmensen C. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature. 2014;509(7499):183-8.

54. Speck M., Cho Y. M., Asadi A., Rubino F., Kieffer T. J. Duodenal-jejunal bypass protects GK rats from {beta}-cellloss and aggravation of hyperglycemia and increasesenteroendocrine cells coexpressing GIP and GLP-1. Am J Physiol Endocrinol Metab. 2011 May;300(5): E923-32.

55. Patriti A., Aisa M. C., Annetti C., Sidoni A., Galli F., Ferri I., Gullà N., Donini A. How the hindgut can cure type 2 diabetes. Ilealtransposition improves glucose metabolism and beta-cellfunction in Goto-kakizaki rats through an enhanced Proglucagon gene expression and L-cell number. Surgery. 2007 Jul;142(1):74-85.

56. Xu G., Stoffers D. A., Habener J. F., Bonner-Weir S. Exendin-4 stimulates both beta-cell replication and neogenesis, resulting in increased beta-cell mass and improved glucose tolerance in diabetic rats. Diabetes. 1999;48(12):2270-2276.

57. Zhou J., Wang X., Pineyro M. A., Egan J. M. Glucagon-like peptide 1 and exendin-4 convert pancreatic AR42J cells into glucagon- and insulin-producing cells. Diabetes. 1999;48(12):2358-2366.

58. Buteau J., El-Assaad W., Rhodes C. J., et al. Glucagon-like peptide-1 prevents beta cell glucolipotoxicity. Diabetologia. 2004;47(5):806-815.

59. Ley R.E., Backhed F., Turnbaugh P. Obesity alters gut microbial ecology. Proc Natl Acad Sci U S A. 2005;102(31):11070-5.

60. Ley R.E., Turnbaugh P. J., Klein S. Microbial ecology: Human gut microbes associated with obesity. Nature. 2006;444(7122):1022-3.

61. Liou A.P., Paziuk M., Luevano J. J. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):141r-78r.

62. Li J.V., Ashrafian H., Bueter M. Metabolic surgery profoundly influences gut microbial-host metabolic cross-talk. Gut. 2011;60(9):1214-23.

63. Zhang H., DiBaise J.K., Zuccolo A. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci U S A. 2009;106(7):2365-70.

64. Furet J.P., Kong L. C., Tap J. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59(12):3049-57.

65. Pories W.J., Swanson M. S., MacDonald K.G., et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-50. discussion 350-352.

66. Adami G.F., Cordera R., Camerini G., Marinari G. M., Scopinaro N. Long-term normalization of insulin sensitivity following biliopancreatic diversion for obesity.Int J Obes Relat Metab Disord. 2004;28(5):671-673. doi:10.1038/sj.ijo.0802618

67. Pories W.J., Swanson M. S., MacDonald K.G., et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-50. discussion 350-352.

68. Rubino F., Kaplan L. M., Schauer P. R., et al. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251:399-405.

69. Schauer P.R., Burguera B., Ikramuddin S., et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003 Oct;238(4):467-84.

70. Ikramuddin S., Billington C., Lee W. J., et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomized, controlled trial. Lancet Diabetes Endocrinol. 2015;3:413-22.

71. Ramos-Leví A.M., Matía P., Cabrerizo L., et al. C-peptide levels predict type 2 diabetes remission after bariatric surgery. Nutr Hosp. 2013;28(5):1599-1603. doi:10.3305/nh.2013.28.5.6554

72. Huang C.K., Shabbir A., Lo C. H., Tai C. M., Chen Y. S., Houng J. Y. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25-35. Obesity surgery. 2011; 21(9):1344-9.

73. Deitel M. Update: Why diabetes does not resolve in some patients after bariatric surgery. Obesity surgery. 2011; 21(6):794-6.

74. Hayes M.T., Hunt L. A., Foo J., et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery. Obes Surg. 2011;21:910-6.

75. Ramos- Levi A. M., Matia P., Cabrerizo L., et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014;6:472-7.

76. Lee W.J., Hur K. Y., Lakadawala M., et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379-84.

77. Still C.D., Wood G. C., Benotti P., et al. A probability score for preoperative prediction of type 2 diabetes remission following RYGB surgery. Lancet Diabetes Endocrinol. 2014;2:38-45.

78. Aminian A.1., Brethauer S. A., Andalib A., et al. Individualized Metabolic Surgery Score: Procedure Selection Based on Diabetes Severity. Ann Surg. 2017 Oct;266(4):650-657.

79. Yska J.P., van Roon E. N., de Boer A., Leufkens H. G., Wilffert B., de Heide L. J., et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population based cohort study in the United Kingdom. JAMA Surg. 2015; 150:1126-33.

80. Schauer P.R., Kashyap S. R., Wolski K., et al. Bariatric Sugery versus intensive medical therapy in obese patients with diabetes. N ENgl J Med. 2012;366:1567-76.

81. Laferrère B., Teixeira J., McGinty J., et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479-85.

82. Rubino F., Nathan D. M., Eckel R. H., et al.; Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Delegates of the 2nd Diabetes Surgery Summit. Obes Surg. 2017 Jan;27(1):2-21.

83. Sjöström L., Lindroos A. K., Peltonen M., et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl JMed. 2004;351:2683-93., 61-65, 94.

84. Sjöström L., Peltonen M., Jacobson P., et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311:2297-304.

85. Adams T.D., Davidson L. E., Litwin S. E., et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122-31.

86. Sjöström L., Gummesson A., Sjöström C. D., et al. Swedish Obese Subjects Study. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653-62.

87. Sjöström L., Peltonen M., Jacobson P., et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56-65.

88. Sjöström L., Narbro K., Sjöström C. D., et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52.

89. Adams T.D., Gress R. E., Smith S. C., et al. Longterm mortality after gastric bypass surgery. N Engl J Med. 2007;357:753-61.

90. Arterburn D.E., Olsen M. K., Smith V. A., et al. Association between bariatric surgery and longterm survival. JAMA. 2015;313:62-70.

91. Iaconelli A., Panunzi S., De Gaetano A., et al. Effects of biliopancreatic diversion on diabetic complications: a 10-year followup. Diabetes Care. 2011;34:561-7.

92. Sjöström L., Lindroos A. K., Peltonen M., et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl Jmed. 2004;351:2683-93.

93. Pories W.J., Swanson M. S., MacDonald K.G., et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-50. discussion 350-352.

94. Rubino F., Shukla A., Pomp A., et al. Bariatric, metabolic, and diabetes surgery: what’s in a name? Ann Surg. 2014;259:117-22.

95. Ali M.K., Bullard K. M., Saaddine J. B., Cowie C. C., Imperatore G., Gregg E. W. Achievement of goals in U.S. diabetes care, 1999-2010 [published correction appears in N Engl J Med. 2013 Aug 8;369(6):587]. N Engl J Med. 2013;368(17):1613-1624. doi:10.1056/NEJMsa1213829

96. Schauer P.R., Mingrone G., Ikramuddin S., Wolfe B. Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes. Diabetes Care. 2016;39(6):902-911. doi:10.2337/dc16-0382

97. Stamler R., Stamler J., Riedlinger W. F., Algera G., Roberts R. H. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA. 1978 Oct 6;240(15):1607-10.

98. Buchwald H., Avidor Y., Braunwald E., Jensen M. D., Pories W., Fahrbach K., Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

99. Vest A.R., Heneghan H. M., Agarwal S., Schauer P. R., Young J. B. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98:1763-1777.

100. Wilhelm S.M., Young J., Kale-Pradhan P. B. Effect of bariatric surgery on hypertension: a meta-analysis. Ann Pharmacother. 2014;48:674-682.

101. Sarkhosh K, Birch DW, Shi X, Gill RS, Karmali S. The impact of sleeve gastrectomy on hypertension: a systematic review. Obes Surg.2012;22:832-837. doi: 10.1007/s11695-012-0615-2

102. Shimada YJ, Tsugawa Y, Iso H, Brown DFM, Hasegawa K Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study. BMC Med. 2017 Aug 23; 15(1):161.

103. Schiavon C.A., Bersch-Ferreira A.C., Santucci E. V., Oliveira J. D., Torreglosa C. R., Bueno P. T., et al. Effects of bariatric surgery in obese patients with hypertension: the gateway randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137:1132-42.

104. Pareek M., Bhatt D. L., Schiavon C. A., Schauer P. R. Metabolic Surgery for Hypertension in Patients With Obesity. Circ Res. 2019;124(7):1009-1024. doi:10.1161/CIRCRESAHA.118.313320

105. Ortiz-Gomez C., Romero-Funes D., Gutierrez-Blanco D., et al. Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease. Surg Endosc. 2019 Sep 6. doi: 10.1007/s00464-019-07094-1

106. Głuszewska A., Gryglewska B., Gąsowski J., et al. Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension. Eur J Intern Med. 2019 Feb;60:39-45.

107. Sjöström L. J. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J.Intern. Med. 2013; 273 (3): 219-234.

108. Sheng B., Truong K., Spitler H., Zhang L., Tong X., Chen L. The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis. Obes Surg. 2017 Oct;27(10):2724-2732.

109. Van Gaal L., Mertens I., De Block C. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444:875-880.

110. Vogel J., Franklin B., Zalesin K., Trivax J., Krause K., Chengelis D., Mccullough P. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol. 2007;99:222-226.

111. Arteburn D., Schauer D., Wise R., Gersin K., Fischer D., Selwyn C., Erisman A., Tsevat J. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:184-189.

112. Chen Y., Corsino L., Shantavasinkul P., Grant J., Portenier D., Ding L., Torquati A. Gastric bypass surgery leads to long-term remission or improvement of type 2 diabetes and significant decrease of microvascular and macrovascular complications. Ann Surg. 2016;263:1138-1142.

113. Aggarwal R., Harling L., Efthimiou E., Darzi A., Athanasiou T., Ashrafian H. The effects of bariatric surgery on cardiac structure and function: a systematic review of cardiac imaging outcomes. Obes Surg. 2016;26:1030-1040.

114. Benotti P.N., Wood G. C., Carey D. J., et al. Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure. J Am Heart Assoc. 2017 May 23;6(5). pii: e005126. doi: 10.1161/JAHA.116.005126

115. Domienik-Karlowicz J., Rymarczyk Z., Dzikowska-Diduch O., Wojciech L., Chmura A., Demkow U., Pruszczyk P. Emerging markers of atherosclerosis before and after bariatric surgery. Obes Surg. 2015;25:486-493.

116. Hafida S., Mirshahi T., Nikolajczyk B. The impact of bariatric surgery on inflammation: quenching the fire of obesity. Curr Opin Endocrinol Diabetes Obes. 2016;23:373-378.

117. Coimbra S., Reis F., Ferreira C., et al. Weight loss achieved by bariatric surgery modifies high-density lipoprotein subfractions and low-density lipoprotein oxidation towards atheroprotection. Clin Biochem. 2019 Jan;63:46-53.

118. Lira N.S., Macedo C. E.S., Belo G. M., et al. Analysis of the lipid profile of patients submitted to sleeve gastrectomy and Roux-en-Y gastric bypass. Rev Col Bras Cir. 2018 Dec 10;45(6): e1967.

119. Climent E., Benaiges D., Flores-Le Roux J. A., et al. Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2018 Aug;14(8):1099-1105.

120. Bagheri M.J., Talebpour M., Sharifi A., et al. Lipid profile change after bariatric surgeries: laparoscopic gastric plication versus mini gastric bypass. Acta Chir Belg. 2019 Jun;119(3):146-151.

121. Osto E., Doytcheva P., Corteville C., et al. Rapid and body weight-independent improvement of endothelial and high-density lipoprotein function after Roux-en-Y gastric bypass. Role of glucagon-like peptide-1. Circulation. 2015;131:871-881.

122. Schiavon C.A., Bersch-Ferreira A.C., et al. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (GastricBypass to Treat Obese Patients With Steady Hypertension). Circulation. 2018 Mar 13;137(11):1132-1142. doi: 10.1161/CIRCULATIONAHA.117.032130

123. Ahmed A.R., Rickards G., Coniglio D., Xia Y., Johnson J., Boss T., O’Malley W. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg. 2009;19:845-849.

124. Peterli R., Steinert R. E., Woelnerhanssen B., et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22:740-748.

125. Bariatric Surgical Practice Guide: Recommendations. Editor-in-Chief: Praveen Raj Palanivelu. Springer. 2017. 309 p.

126. Belentani S., et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med, 2000, no.132, pp.112-117.

127. Drapkina O.M., Ivashkin V. T. Epidemiologic features of non-alcoholic fatty liver disease in Russia.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014;24(4):32-38. (in Russ.)@@ Драпкина О. М., Ивашкин В. Т. Эпидемиологические особенности неалкогольной жировой болезни печени в России (результаты открытого многоцентрового проспективного исследования наблюдения DIREGL 01903). Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2014, т. 24, № 4, с. 32-38.

128. Ivashkin V.T., Drapkina O. M., Maev I. V., et al. Prevalence of non-alcoholic fatty liver disease in out-patients of the Russian Federation: DIREG 2 study results.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015;25(6):31-41. (in Russ.)@@ Ивашкин В. Т., Драпкина О. М., Маев И. В., Трухманов А. С., Блинов Д. В., Пальгова Л. К., Цуканов В. В., Ушакова Т. И. Распространенность неалкогольной жировой болезни печени у пациентов амбулаторно-поликлинической практики в Российской Федерации: результаты исследования DIREG 2. Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2015, № 6, с. 31-41.

129. Clemente M.G., Mandato C., Poeta M., Vajro P. Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions. World J Gastroenterol. 2016;22(36):8078-93.

130. Wong R.J., Aguilar M., Cheung R., et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;(148):547-555.

131. Major P., Pędziwiatr M., Rubinkiewicz M., et al. Impact of bariatric surgery on non-alcoholic fatty liver disease. Pol. Przegl. Chir. 2017;89(2):1-4.

132. Dixon J.B., Bhathal P. S., O’Brien P. E. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes. Surg. 2006;16(10):1278-86.

133. Mathurin P., Hollebecque A., Arnalsteen L., et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137(2):532-540.

134. Froylich D., Corcelles R., Daigle C., Boules M., Brethauer S., Schauer P. Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on nonalcoholic fatty liver disease: a comparative study. Surg. Obes. Relat. Dis. 2016;12(1):127-131.

135. Aldoheyan T., Hassanain M., Al-Mulhim A., Al-Sabhan A., Al-Amro S., Bamehriz F., Al-Khalidi H. The effects of bariatric surgeries on nonalcoholic fatty liver disease. Surg. Endosc. 2017;31(3):1142-1147.

136. Alli V., Rogers A. M. Gastric Bypass and Influence on Improvement of NAFLD. Curr Gastroenterol Rep. 2017;19(6):25. doi:10.1007/s11894-017-0567-8

137. Winder J.S., Dudeck B. S., Schock S., Lyn-Sue J.R., Haluck R. S., Rogers A. M. Radiographic Improvement of Hepatic Steatosis After Laparoscopic Roux-en-Y Gastric Bypass. Obes. Surg. 2017;27(2):376-380.

138. Aguilar-Olivos N.E., Almeda-Valdes P., Aguilar-Salinas C.A., Uribe M., Méndez-Sánchez N. The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome. Metabolism. 2016;65(8):1196-1207.

139. Ooi G.J., Burton P. R., Doyle L., et al. Effects of Bariatric Surgery on Liver Function Tests in Patients with Nonalcoholic Fatty Liver Disease. Obes. Surg. 2017;27(6):1533-1542.

140. Stoyanov T., Cascales Sanchez P., Garcia Blazquez E., et al. Preoperative Nafld and Improved Liver Function after Biliopancreatic Derivation with Duodenal Switch in Morbidly Obese. Clinical Nutrition. 2016, Vol.35, 230 P.

141. Cazzo E., Pareja J. C., Chaim E. A. Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review. Sao Paulo Med. J. 2017;135(3):277-295.

142. Chavez-Tapia N.C., Tellez-Avila F.I., Barrientos-Gutierrez T., Mendez-Sanchez N., Lizardi-Cervera J., Uribe M. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;2010(1): CD007340. Published 2010 Jan 20. doi:10.1002/14651858.CD007340.pub2

143. Shouhed D., Steggerda J., Burch M., Noureddin M. The role of bariatric surgery in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Expert Rev Gastroenterol Hepatol. 2017;11(9):797-811. doi:10.1080/ 17474124.2017.1355731

144. Kral J.G., Thung S. N., Biron S., et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48-58. doi:10.1016/j.surg.2003.10.003.