METHOD OF PERSONALIZED LAPAROSCOPIC MINIGASTRIC BYPASS USING 3D MODELING AND MECHANICAL CALIBRATION IN PATIENTS WITH SEVERE METABOLIC SYNDROME

According to the definition of the International Diabetes Federation, metabolic syndrome is a cluster of metabolic disorders, including abdominal obesity, insulin resistance, hypertension, and dyslipidemia, which collectively lead to a substantial increase in cardiovascular risk, progression of diabetes mellitus, and development of non-alcoholic fatty liver disease. The purpose of the study: To develop a personalized laparoscopic mini-bypass surgery approach using 3D modeling and mechanical calibration in patients with severe metabolic syndrome. Materials and methods. This stage of the work focused on clinical evaluation and implementation of the proposed method in patients with severe metabolic syndrome, for whom, according to medical history, instrumental investigations, and assessment of the somatic background, other bariatric procedures were associated with a high risk of unsatisfactory outcomes or severe malabsorption-related complications. The intervention was positioned as the method of choice, with clearly defined indications that excluded the feasibility of alternative surgical tactics. The principles of bioethics, approved by the Scientific Council of Bukhara State Medical Institute, are preserved and upheld in full compliance. Statistical analyses were performed using SPSS 26.0. Data are presented as arithmetic mean (M) ± standard deviation (SD) or standard error of the mean (m). Differences were evaluated using Student's t-test and the Mann–Whitney U-test. A p-value < 0.05 was considered statistically significant. The study was conducted in accordance with the research plan of the Bukhara State Medical Institute within the framework of the topic "Early detection and diagnosis of pathological factors affecting the health of the population of the Bukhara region in the post-COVID-19 period, as well as the development of new methods of treatment and prevention (2022-2026)". The results and their discussion. The early postoperative course in all patients was uneventful. The mean length of hospital stay was 6.1 ± 1.4 days, with recovery of intestinal motility observed in most cases within the first 24–36 hours. By postoperative day 2, patients began clear liquid intake, progressing to fractional enteral nutrition with protein supplementation by days 4–5. No clinically significant complications related to the surgical technique were recorded, including gastroenteroanastomotic leakage, intra-abdominal bleeding, abscess formation, or visceral perforation. Conclusion. Modified bariatric procedures, personalized to the patient’s clinical and anatomical profile, demonstrated marked advantages over standard approaches. Twelve months postoperatively, complete remission of type 2 diabetes mellitus was achieved in 100% of patients in the main group, with percentage excess weight loss (% EWL ≥ 50%) in 98.3%. No cases of hypoproteinemia occurred, and physiological vitamin levels were maintained. Quality-of-life scores were 26% higher on the GIQLI scale compared with the control group, while BAROS-3 assessment indicated improvements in physical, social, psycho-emotional, and occupational domains. These findings support the clinical validity of personalized surgical strategies as the preferred approach for managing patients with metabolic syndrome.

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