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Бариатрический пациент: основные аспекты подготовки к хирургическому лечению ожирения и ведения после него. Лекция для практических врачей
Бариатрический пациент: основные аспекты подготовки к хирургическому лечению ожирения и ведения после него. Лекция для практических врачей
Ершова Е.В., Комшилова К.А., Мазурина Н.В., Трошина Е.А. Бариатрический пациент: основные аспекты подготовки к хирургическому лечению ожирения и ведения после него. Лекция для практических врачей. Consilium Medicum. 2021; 23 (4): 339–346. DOI: 10.26442/20751753.2021.4.200831
Слушать анонс номера от главного редактора Е.А.Трошиной
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Слушать анонс номера от главного редактора Е.А.Трошиной
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Аннотация
На протяжении последних лет и десятилетий во всем мире в целом и в России в частности для лечения тяжелых форм ожирения бариатрическая хирургия получает все более широкое распространение, при этом наблюдается как увеличение количества выполняемых операций, так и накопление опыта в отношении их безопасности и эффективности, а также совершенствование хирургических методик. В данной лекции четко обозначены показания и противопоказания к хирургическому лечению ожирения. Описаны различные виды бариатрических операций и патофизиологические механизмы их влияния на массу тела, углеводный и липидный обмен, а также продемонстрирована их эффективность при коморбидной ожирению патологии, в первую очередь у пациентов с сахарным диабетом 2-го типа (СД 2). Продемонстрированы требования к бариатрическим операциям и приведены параметры оценки их эффективности, в том числе ремиссии СД 2. Проанализированы возможные осложнения хирургических методов лечения ожирения, в том числе вторичный гиперпаратиреоз, постбариатрические гипогликемии и другие, а также предикторы послеоперационного прогноза в отношении метаболического контроля у пациентов с ожирением и СД 2.
Ключевые слова: ожирение, сахарный диабет 2-го типа, бариатрические операции
Keywords: obesity, type 2 diabetes mellitus, bariatric surgery
Ключевые слова: ожирение, сахарный диабет 2-го типа, бариатрические операции
________________________________________________
Keywords: obesity, type 2 diabetes mellitus, bariatric surgery
Полный текст
Список литературы
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23. Tsur A, Machtinger R, Segal-Lieberman G, et al. Obesity, bariatric surgery and future fertility. Harefuah. 2014;153(8):478-81.
24. Heber D, Greenway F, Kaplan L, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823-43.
25. Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the European association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597-632.
26. The American Congress of Obstetricians and Gynecologists (ACOG): ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405-13.
27. Kushner RF, Sorensen KW. Prevention of weight regain following bariatric surgery. Curr Obes Rep. 2015;4:198-206.
28. International Diabetes Federation. Available at: https://www.idf.org/
29. Aminian A, Brethauer S, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650-7.
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31. American Diabetes Association. Diabetes Care. 2021;44(Suppl.1):S73-84. DOI:10.2337/dc21-S006
32. Patti ME, Goldfine AB, Hu J, et al. Heterogeneity of proliferative markers in pancreatic β-cells of patients with severe hypoglycemia following Roux-en-Y gastric bypass. Acta Diabetol. 2017;54(8):737-47. DOI:10.1007/s00592-017-1001-2
33. Вaggio L, Drucker D. Biology of incretins: GLP-1 and GIP. Gastroenterology. 2007;132:2131-57.
34. Holst J. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36:747-54.
35. Rabiee A, Magruder J, Salas-Carrillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: Unraveling the roles of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;167:199-205.
36. Salehi M, Gastaldelli A, D’Alessio DA. Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J Clin Endocrinol Metab. 2014;99(6):2008-17. DOI:10.1210/jc.2013-2686
37. Abrahamsson N, Borjesson JL, Sundbom M, et al. Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes. 2016;9:2667-75.
38. Salehi M, Woods SC, D’Alessio DA. Gastric bypass alters both glucose-dependent and glucose-independent regulation of islet hormone secretion. Obesity (Silver Spring). 2015;10:2046-52.
39. Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4(4):492-9. DOI:10.1016/j.soard.2008.05.005
40. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-85.
41. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:249-61.
42. Musella М, Susa A, Manno E, et al. Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obesity Surgery. 2017;11(27):2956-67.
43. Dindo D, Demartines S, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
44. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017;13:727-41.
2. American Society for Metabolic and Bariatric Surgery. Available at: https://asmbs.org/.
3. IFSO 2018 23rd World Congress Obesity Surgery. 2018;28(Suppl.2):131-1271.
4. Fried M, Yumuk V, Oppert J, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. International Federation for the Surgery of Obesity and Metabolic Disorders – European Chapter (IFSO – EC) and European Association for the Study of Obesity (EASO). Obes Surg. 2014;24(1):42-55.
5. Лечение морбидного ожирения. Национальные клинические рекомендации. Ожирение и метаболизм. 2018;1:53-70 [Lechenie morbidnogo ozhireniia. Natsional’nye klinicheskie rekomendatsii. Ozhirenie i metabolizm. 2018;1:53-70 (in Russian)].
6. Дедов И.И., Шестакова М.В., Мельниченко Г.А., и др. Междисциплинарные клинические рекомендации «Лечение ожирения и коморбидных заболеваний». Ожирение и метаболизм. 2021;18(1):5-99 [Dedov II, Shestakova MV, Mel’nichenko GA, et al. Mezhdistsiplinarnye klinicheskie rekomendatsii “Lechenie ozhireniia i komorbidnykh zabolevanii”. Ozhirenie i metabolizm. 2021;18(1):5-99 (in Russian)]. DOI:10.14341/omet12714
7. Koehestanie P, de Jonge C, Berends FJ, et al. The effect of the endoscopic duodenojejunal bypass liner on obesity and diabetes mellitus, a multicenter randomized control trial. Ann Surg. 2014;260:984-92.
8. Яшков Ю.И., Ершова Е.В. «Метаболическая» хирургия. Ожирение и метаболизм. 2011;3:65-8 [Iashkov IuI, Ershova EV. “Metabolicheskaia” khirurgiia. Ozhirenie i metabolizm. 2011;3:65-8 (in Russian)].
9. Flancbaum L. Mechanisms of weight loss after surgery for clinically severe obesity. Obes Surg. 1999;9(6):516-23.
10. Kulick D, Hark L, Deen D. The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc. 2010;110:593-9.
11. Jastrzebska-Mierzyńska M, Ostrowska L, Wasiluk D, Konarzewska-Duchnowska E. Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery. Rocz Panstw Zakl Hig. 2015;66:13-9.
12. Handzlik-Orlik G, Holecki M, Orlik B, et al. Nutrition management of the post-bariatric surgery patient. Nutr Clin Prac. 2015;30(3):383-92.
13. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update. Obesity (Silver Spring). 2013;21(Suppl.1):S1-27.
14. Isom KA, Andromalos L, Ariagno M, et al. Nutrition and metabolic support recommendations for the bariatric patient. Nutr Clin Pract. 2014;29(6):718-39.
15. Aills L, Blankenship J, Buffington C, et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008;4(Suppl.5):S73-108.
16. Dagan S, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382-94.
17. Parikh M, Johnson JM, Ballem N. ASMBS position statement on alcohol use before and after bariatric surgery. Surg Obes Relat Dis. 2016;12(2):225-30.
18. Wee CC, Mukamal KJ, Huskey KW, et al. High-risk alcohol use after weight loss surgery. Surg Obes Relat Dis. 2014;10:508-13.
19. Heneghan HM, Heinberg L, Windover A, et al. Weighing the evidence for an association between obesity and suicide risk. Surg Obes Relat Dis. 2012;8:98-107.
20. Tindle HA, Omalu B, Courcoulas A, et al. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med. 2010;123:1036-42.
21. Chen EY, Fettich KC, McCloskey MS. Correlates of suicidal ideation and/or behavior in bariatric-surgery-seeking individuals with severe obesity. Crisis. 2012;33:137-43.
22. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189-201.
23. Tsur A, Machtinger R, Segal-Lieberman G, et al. Obesity, bariatric surgery and future fertility. Harefuah. 2014;153(8):478-81.
24. Heber D, Greenway F, Kaplan L, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823-43.
25. Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the European association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597-632.
26. The American Congress of Obstetricians and Gynecologists (ACOG): ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405-13.
27. Kushner RF, Sorensen KW. Prevention of weight regain following bariatric surgery. Curr Obes Rep. 2015;4:198-206.
28. International Diabetes Federation. Available at: https://www.idf.org/
29. Aminian A, Brethauer S, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650-7.
30. Raveendran AV, Shiji PV, Pappachan JM. Role of bariatric surgery in type 2 diabetes. BMH Med J. 2017;4(1):6-16.
31. American Diabetes Association. Diabetes Care. 2021;44(Suppl.1):S73-84. DOI:10.2337/dc21-S006
32. Patti ME, Goldfine AB, Hu J, et al. Heterogeneity of proliferative markers in pancreatic β-cells of patients with severe hypoglycemia following Roux-en-Y gastric bypass. Acta Diabetol. 2017;54(8):737-47. DOI:10.1007/s00592-017-1001-2
33. Вaggio L, Drucker D. Biology of incretins: GLP-1 and GIP. Gastroenterology. 2007;132:2131-57.
34. Holst J. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36:747-54.
35. Rabiee A, Magruder J, Salas-Carrillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: Unraveling the roles of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;167:199-205.
36. Salehi M, Gastaldelli A, D’Alessio DA. Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J Clin Endocrinol Metab. 2014;99(6):2008-17. DOI:10.1210/jc.2013-2686
37. Abrahamsson N, Borjesson JL, Sundbom M, et al. Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes. 2016;9:2667-75.
38. Salehi M, Woods SC, D’Alessio DA. Gastric bypass alters both glucose-dependent and glucose-independent regulation of islet hormone secretion. Obesity (Silver Spring). 2015;10:2046-52.
39. Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4(4):492-9. DOI:10.1016/j.soard.2008.05.005
40. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-85.
41. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:249-61.
42. Musella М, Susa A, Manno E, et al. Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obesity Surgery. 2017;11(27):2956-67.
43. Dindo D, Demartines S, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
44. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017;13:727-41.
2. American Society for Metabolic and Bariatric Surgery. Available at: https://asmbs.org/.
3. IFSO 2018 23rd World Congress Obesity Surgery. 2018;28(Suppl.2):131-1271.
4. Fried M, Yumuk V, Oppert J, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. International Federation for the Surgery of Obesity and Metabolic Disorders – European Chapter (IFSO – EC) and European Association for the Study of Obesity (EASO). Obes Surg. 2014;24(1):42-55.
5. Лечение морбидного ожирения. Национальные клинические рекомендации. Ожирение и метаболизм. 2018;1:53-70 [Lechenie morbidnogo ozhireniia. Natsional’nye klinicheskie rekomendatsii. Ozhirenie i metabolizm. 2018;1:53-70 (in Russian)].
6. Дедов И.И., Шестакова М.В., Мельниченко Г.А., и др. Междисциплинарные клинические рекомендации «Лечение ожирения и коморбидных заболеваний». Ожирение и метаболизм. 2021;18(1):5-99 [Dedov II, Shestakova MV, Mel’nichenko GA, et al. Mezhdistsiplinarnye klinicheskie rekomendatsii “Lechenie ozhireniia i komorbidnykh zabolevanii”. Ozhirenie i metabolizm. 2021;18(1):5-99 (in Russian)]. DOI:10.14341/omet12714
7. Koehestanie P, de Jonge C, Berends FJ, et al. The effect of the endoscopic duodenojejunal bypass liner on obesity and diabetes mellitus, a multicenter randomized control trial. Ann Surg. 2014;260:984-92.
8. Яшков Ю.И., Ершова Е.В. «Метаболическая» хирургия. Ожирение и метаболизм. 2011;3:65-8 [Iashkov IuI, Ershova EV. “Metabolicheskaia” khirurgiia. Ozhirenie i metabolizm. 2011;3:65-8 (in Russian)].
9. Flancbaum L. Mechanisms of weight loss after surgery for clinically severe obesity. Obes Surg. 1999;9(6):516-23.
10. Kulick D, Hark L, Deen D. The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc. 2010;110:593-9.
11. Jastrzebska-Mierzyńska M, Ostrowska L, Wasiluk D, Konarzewska-Duchnowska E. Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery. Rocz Panstw Zakl Hig. 2015;66:13-9.
12. Handzlik-Orlik G, Holecki M, Orlik B, et al. Nutrition management of the post-bariatric surgery patient. Nutr Clin Prac. 2015;30(3):383-92.
13. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update. Obesity (Silver Spring). 2013;21(Suppl.1):S1-27.
14. Isom KA, Andromalos L, Ariagno M, et al. Nutrition and metabolic support recommendations for the bariatric patient. Nutr Clin Pract. 2014;29(6):718-39.
15. Aills L, Blankenship J, Buffington C, et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008;4(Suppl.5):S73-108.
16. Dagan S, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382-94.
17. Parikh M, Johnson JM, Ballem N. ASMBS position statement on alcohol use before and after bariatric surgery. Surg Obes Relat Dis. 2016;12(2):225-30.
18. Wee CC, Mukamal KJ, Huskey KW, et al. High-risk alcohol use after weight loss surgery. Surg Obes Relat Dis. 2014;10:508-13.
19. Heneghan HM, Heinberg L, Windover A, et al. Weighing the evidence for an association between obesity and suicide risk. Surg Obes Relat Dis. 2012;8:98-107.
20. Tindle HA, Omalu B, Courcoulas A, et al. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med. 2010;123:1036-42.
21. Chen EY, Fettich KC, McCloskey MS. Correlates of suicidal ideation and/or behavior in bariatric-surgery-seeking individuals with severe obesity. Crisis. 2012;33:137-43.
22. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189-201.
23. Tsur A, Machtinger R, Segal-Lieberman G, et al. Obesity, bariatric surgery and future fertility. Harefuah. 2014;153(8):478-81.
24. Heber D, Greenway F, Kaplan L, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823-43.
25. Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the European association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597-632.
26. The American Congress of Obstetricians and Gynecologists (ACOG): ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405-13.
27. Kushner RF, Sorensen KW. Prevention of weight regain following bariatric surgery. Curr Obes Rep. 2015;4:198-206.
28. International Diabetes Federation. Available at: https://www.idf.org/
29. Aminian A, Brethauer S, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650-7.
30. Raveendran AV, Shiji PV, Pappachan JM. Role of bariatric surgery in type 2 diabetes. BMH Med J. 2017;4(1):6-16.
31. American Diabetes Association. Diabetes Care. 2021;44(Suppl.1):S73-84. DOI:10.2337/dc21-S006
32. Patti ME, Goldfine AB, Hu J, et al. Heterogeneity of proliferative markers in pancreatic β-cells of patients with severe hypoglycemia following Roux-en-Y gastric bypass. Acta Diabetol. 2017;54(8):737-47. DOI:10.1007/s00592-017-1001-2
33. Вaggio L, Drucker D. Biology of incretins: GLP-1 and GIP. Gastroenterology. 2007;132:2131-57.
34. Holst J. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36:747-54.
35. Rabiee A, Magruder J, Salas-Carrillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: Unraveling the roles of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;167:199-205.
36. Salehi M, Gastaldelli A, D’Alessio DA. Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J Clin Endocrinol Metab. 2014;99(6):2008-17. DOI:10.1210/jc.2013-2686
37. Abrahamsson N, Borjesson JL, Sundbom M, et al. Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes. 2016;9:2667-75.
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43. Dindo D, Demartines S, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
44. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017;13:727-41.
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33. Вaggio L, Drucker D. Biology of incretins: GLP-1 and GIP. Gastroenterology. 2007;132:2131-57.
34. Holst J. On the physiology of GIP and GLP-1. Horm Metab Res. 2004;36:747-54.
35. Rabiee A, Magruder J, Salas-Carrillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: Unraveling the roles of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;167:199-205.
36. Salehi M, Gastaldelli A, D’Alessio DA. Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia. J Clin Endocrinol Metab. 2014;99(6):2008-17. DOI:10.1210/jc.2013-2686
37. Abrahamsson N, Borjesson JL, Sundbom M, et al. Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes. 2016;9:2667-75.
38. Salehi M, Woods SC, D’Alessio DA. Gastric bypass alters both glucose-dependent and glucose-independent regulation of islet hormone secretion. Obesity (Silver Spring). 2015;10:2046-52.
39. Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4(4):492-9. DOI:10.1016/j.soard.2008.05.005
40. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-85.
41. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:249-61.
42. Musella М, Susa A, Manno E, et al. Complications Following the Mini/One Anastomosis Gastric Bypass (MGB/OAGB): a Multi-institutional Survey on 2678 Patients with a Mid-term (5 Years) Follow-up. Obesity Surgery. 2017;11(27):2956-67.
43. Dindo D, Demartines S, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
44. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017;13:727-41.
Авторы
Е.В. Ершова*, К.А. Комшилова, Н.В. Мазурина, Е.А. Трошина
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*yu99pol06@rambler.ru
Endocrinology Research Centre, Moscow, Russia
*yu99pol06@rambler.ru
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*yu99pol06@rambler.ru
________________________________________________
Endocrinology Research Centre, Moscow, Russia
*yu99pol06@rambler.ru
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