Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector62918710.17816/medjrf629187ReviewsНаучные обзорыReview ArticleBile reflux after laparoscopic mini/one anastomosis gastric bypass: the problem and preventionБилиарный рефлюкс после лапароскопического минигастрошунтирования: проблема и профилактикаhttps://orcid.org/0000-0002-8995-28625070-8140VinnikYurii S.ВинникЮрий Семенович
Russian Federation

MD, Dr. Sci. (Medicine), professor

д-р мед. наук, профессор

yuvinnik@ya.ruhttps://orcid.org/0009-0009-0994-081X8291-9867ChaykinAleksandr A.ЧайкинАлександр Александрович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

chaiki@inbox.ruhttps://orcid.org/0000-0003-0098-17614098-5263ChaykinDmitriy A.ЧайкинДмитрий Александрович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

conte4@yandex.ruhttps://orcid.org/0000-0003-0005-331657627507000M-7060-20144975-0569TeplyakovaOlga V.ТепляковаОльга Валериевна
Russian Federation

MD, Dr. Sci. (Medicine), professor

д-р мед. наук, профессор

teplyakova-olga@ya.ruhttps://orcid.org/0009-0005-9185-278X4551-1020YurevaMargarita Y.ЮрьеваМаргарита Юрьевна
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

hizhnenko2009@ya.ruhttps://orcid.org/0000-0002-1761-47172081-2424BoyakovaNina V.БояковаНина Васильевна
Russian Federation

MD, Cand. Sci. (Med.)

канд. мед. наук

n79039248058@gmail.comhttps://orcid.org/0009-0008-8550-5361VlasenkoDmitrii S.ВласенкоДмитрий Сергеевич
Russian Federation
vdima2002@ya.ruhttps://orcid.org/0009-0000-5454-99616989-5951BakhshyanValentina A.БахшянВалентина Артуровна
Russian Federation
v.a.bahshyan@gmail.comProf. V.F. Voino-Yasenetsky Krasnoyarsk State Medical UniversityКрасноярский государственный медицинский университет имени профессора В.Ф. Войно-ЯсенецкогоClinical hospital «RZD-Medicine»Клиническая больница «РЖД-Медицина»21062024100720243032722841803202412052024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://medjrf.com/0869-2106/article/view/629187

Currently, laparoscopic mini-gastric bypass (LMGB) is a common bariatric surgical operation. One of the reasons for reoperations after LMGB is pathological bile reflux, which, in addition to a noticeable decrease in the quality of life of patients, poses a potential threat to the neoplastic processes in the stomach and esophagus.

This study aimed to systematize and analyze modern literature information on terminology, diagnosis and frequency of detection, pathophysiological significance, and methods of preventing bile reflux post-LMGB. Russian and English full-text studies on bile reflux after LMGB in the bibliographic databases of the Russian Science Citation Index, PubMed, Google Scholar, and ScienceDirect were analyzed.

The frequency of diagnosing bile reflux after LMGB varies from 2.0 to 57.9%, depending on the instrumental diagnostic methods used: flexible endoscopy, 24-hour pH impedance measurements, spectrophotometry of bilirubin in refluxate, and hepatobiliary scintigraphy. The pathogenetic effect of the contents of the small intestine on the mucous membrane of the stomach and esophagus after LMGB is noted because of the direct cytotoxic and receptor-mediated effects of bile acids. The safety of the main stages of LMGB (creation of a gastric pouch and formation of a single anastomosis) is currently being reviewed from the standpoint of minimizing the risk of developing bile reflux. Furthermore, novel techniques have been proposed to reduce the likelihood of intestinal contents entering the stomach and esophagus; however, their effectiveness remains controversial.

Лапароскопическое минигастрошунтирование (ЛМГШ) в настоящее время относится к числу трёх наиболее распространённых бариатрических операций. Одной из причин повторных операций после ЛМГШ является патологический билиарный рефлюкс, который помимо снижения качества жизни пациентов представляет собой потенциальную угрозу для развития неопластических процессов в желудке и пищеводе.

В обзоре проанализированы и систематизированы современные литературные сведения о терминологии, диагностике, частоте выявления, патофизиологическом значении и методах профилактики билиарного рефлюкса после ЛМГШ. Выполнен анализ русско- и англоязычных полнотекстовых литературных источников по проблеме билиарного рефлюкса после ЛМГШ в библиографических базах Российского индекса научного цитирования, PubMed, Google Scholar, ScienceDirect.

Установлено, что частота диагностики билиарного рефлюкса после ЛМГШ варьируется от 2,0 до 57,9% в зависимости от используемых методов инструментальной диагностики: гибкой эндоскопии, суточной pH-импедансометрии, фиброоптической спектрофотометрии билирубина в рефлюксате, гепатобилиарной сцинтиграфии. Показано, что патогенетическое воздействие содержимого тонкой кишки на слизистую оболочку желудка и пищевода после ЛМГШ реализуется в основном за счёт прямого цитотоксического и рецептор-опосредованных эффектов желчных кислот. Безопасность основных этапов ЛМГШ (создание желудочного пауча и формирование единственного анастомоза) в настоящее время пересматривается с позиции минимизации риска развития билирного рефлюкса. Помимо этого предлагаются новые технические приёмы, направленные на снижение вероятности поступления кишечного содержимого в пауч желудка и пищевод, однако их эффективность остаётся дискутабельной.

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