Вестник хирургии казахстана

BULLETIN OF SURGERY IN KAZAKHSTAN № 1•2016

41

Picture 3. 

BAROS with Moorehead-

Ardelt II Quality of life 

questionnaire scoring key

major comorbidities are resolved and others slightly 

improved.

The results of scoring of the quality of life deter-

mine that parameters that were rated as “satisfacto-

ry”, after the surgery were rated as “good” (Table 1).

Ultimately, 12 months after surgery, an excel-

lent result according to BAROS scoring system 

was achieved in 10%, very good in 14.2%, good in 

46.8%, satisfactory results in 20% and poor in 9% 

of patients.

Discussion

To evaluate the quality of life of patients, 

some authors use standard tools, such as SF-

36 scale[13], Sickness Impact Profile 68 (SIP 68) 

[14], the Quality of Well-Being Scale  [15]; how-

ever, they have certain disadvantages and do not 

take into account the specificity of obese patients. 

Implementation of the BAROS evaluation sys-

tem after bariatric surgery provides an opportunity 

to assess the response to bariatric intervention 

more explicitly, considering not only the % EWL, but 

also changes in comorbidities and quality of life. 

The questionnaire can be completed in 1 minute 

without anyone’s assistance.

BAROS scores that were used in this study, can 

be suitable for other fields, as mini gastric bypass 

and biliary pancreatic bypass. Favretti [16]  in his 

extensive study of 170 patients, who were observed 

for over 18 months reported the following data: 

poor result was present in more than 10%, sat-

isfactory – in 42%, good (equal to our good and 

very good band) in 44%, and excellent – in 4% of 

the patients. Promising results were obtained by 

Hell. In his study of 30 patients, only 3% received 

poor results, whereas 23% got excellent scores 

[17].  Reports from other researchers, such as Vic-

torzon, Wolf, and Martikainen demonstrate absence 

of patients with excellent scores and predominance 

QUALITY OF LIFE ASSESSNENT IN PATIENTS AFTER FUNDOCORPOROGASROPLICATION 

BASED ON BAROS SCORING SYSTEM

ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 1•2016

42

1.  Whitlock G, Lewington S, Sherliker P, Clarke R, 

Emberson J, Halsey J, Qizilbash N, Collins R, Peto R. 

Body-mass index and cause-specific mortality in 900 

000 adults: collaborative analyses of 57 prospective 

studies. Lancet. 2009;373:1083–1096. [PMC free 

article] [PubMed]

2.  Nandurkar S, Locke GR 3rd, Fett S, Zinsmeister AR, 

Cameron AJ, Talley NJ. Relationship between body 

mass index, diet, exercise and gastro-oesophageal 

reflux symptoms in a community. Aliment Pharmacol 

Ther. 2004;20:497–505. [PubMed]

3. Shaheen N, Provenzale D. The epidemiology 

of gastroesophageal reflux disease. Am J Med 

Sci.2003;326:264–273. [PubMed]

4.  El-Serag HB, Graham DY, Satia JA, Rabeneck 

L. Obesity is an independent risk factor for 

GERD symptoms and erosive esophagitis. Am J 

Gastroenterol. 2005;100:1243–1250. [PubMed]

5.  Cook MB, Greenwood DC, Hardie LJ, Wild CP, Forman 

D. A systematic review and meta-analysis of the risk 

of increasing adiposity on Barrett’s esophagus. Am J 

Gastroenterol. 2008;103:292–300. [PubMed]

6. Thukkani N, Sonnenberg A. The influence of 

environmental risk factors in hospitalization 

for gastro-oesophageal reflux disease-related 

diagnoses in the United States. Aliment Pharmacol 

Ther. 2010;31:852–861. [PubMed]

of patients with poor results, ranging from 12% to 

50% of the patients [18,19,20].  

BAROS has several drawbacks including the 

fact that intraoperative or postoperative mortality 

rate due to weight loss (severe malabsorption, or 

liver failure) is not taken into account. Since such 

patients who underwent surgery with a high rate of 

mortality (eg, biliary pancreatic bypass), who are 

also associated with the highest initial weight loss 

in the point system, gain a good score, although in 

fact it is not good.  BAROS system is well suited 

for Roux-en-Y gastric bypass (RYGB) patients.  In 

reality, excellent results after RYBG were observed 

in 63% of the patients in Hell study, and poor results 

were shown for 0%. Nguyen

   

[21] 6 months after 

surgery, reported excellent scores in 25% and very 

good scores in 47% of the patients who underwent 

laparoscopic RYGB . Marinari [22] in his 15-year 

long observation showed very good BAROS results 

in 39.5% and good scores in 23.2% patients. Given 

the impact of weight loss on the BAROS counting 

system and the absence of any measure of mor-

tality, it is necessary to be cautious in performing 

comparisons among completely different bariatric 

surgeries [23,24].  

In addition to that BAROS does not include one 

more important factor, which is the period of ob-

servation. Like the quality of life of a cancer patient 

is affected by the duration of observation after the 

surgery, the outcomes of any bariatric surgeries 

vary depending on the length of postoperative ob-

servation. In order to achieve % EWL in the range of 

50% to 60% upon restrictive surgeries (gastroplica-

tion, gastric sleeve resection) or controlled bandag-

ing of a stomach, the required period of observation 

should be maintained within 2 to 3 years. Consider-

ing the importance of weight loss in BAROS scoring 

system, RYGB and biliary pancreatic bypass have 

more advantages in short-term observations (2 

years or less) over gastroplication.  

Our results are consistent with the data re-

ported by Favretti; however, the short terms of 

observation affect the results of our survey. Al-

though, it is important to note that almost 100% 

of patients have been cured of GERD and reduced 

their weight. 

Conclusions:

Life quality assessment of fundocorporogas-

troplication patients based on Moorehead-Ardelt 

II (M-A QoLQ II) questionnaire has revealed that 

this type of surgery not only reduced weight and 

resolves symptoms of gastroesophageal reflux dis-

ease, but also improves patients’ quality of life after 

the operation.  

Investigation of quality of life of obese patients 

in accordance with the established system allows 

unification and standardization of the research 

data, therefore correcting.

References

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QUALITY OF LIFE ASSESSNENT IN PATIENTS AFTER FUNDOCORPOROGASROPLICATION 

BASED ON BAROS SCORING SYSTEM

BULLETIN OF SURGERY IN KAZAKHSTAN № 1•2016

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16. Favretti F, Cadiere GB, Segato G, et al. Bariatric 

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gastric bypass, vertical banded gastroplasty and 

laparoscopic adjustable silicone gastric banding. 

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18. Martikainen T, Pirinen E, Alhava E, et al. Long-term 

results, late complications and quality of life in a 

series of adjustable gastric banding. Obes Surg. 

2004; 14: 648–654 [PubMed]

19. Wolf AM, Falcone AR, Kortner B, Kuhlmann HW. 

BAROS: an effective system to evaluate the results 

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20. Victorzon M, Tolonen P. Bariatric Analysis and 

Reporting Outcome System (BAROS) following 

laparoscopic adjustable gastric banding in Finland. 

Obes Surg. 2001; 11: 740–743 [PubMed]

21. Nguyen NT, Goldman C, Rosenquist CJ, et al. 

Laparoscopic versus open gastric bypass: a 

randomized study of outcomes, quality of life, and 

costs. Ann Surg. 2001; 234: 279–291 [PMC free 

article] [PubMed]

22. Marinari GM, Murelli F, Camerini G, et al. A 15-year 

evaluation of biliopancreatic diversion according 

to the bariatric analysis reporting outcome system 

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23. Moneghini D, Mittempergher F, Terraroli C, DiFabio 

F. Bariatric Analysis and Reporting Outcome System 

(BAROS) following biliopancreatic diversion. Annali 

italiani di chirurgia 2004; 75: 417–420[PubMed]

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biliopancreatic diversion after five years. Obes Surg. 

2004; 14: 766–772 [PubMed]

QUALITY OF LIFE ASSESSNENT IN PATIENTS AFTER FUNDOCORPOROGASROPLICATION 

BASED ON BAROS SCORING SYSTEM

ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 1•2016

44

SURGICAL TREATMENT OF RENOVASCULAR 

HYPERTENSION WITH BILATERAL RENAL 

ARTERY STENOSIS.

UDC 616.61-007:616.136.7-

007.271-089

III. ХИРУРГИЯ

Summary

Retrospective analysis of the survey results of 48 patients with RVH in conjunction with the defeat of other pools, as well 

as data on the effectiveness of surgery, allowed us a new aspect to characterize the value of diagnostic tests aimed at 

determining the functional significance of the defeat of the  R.A.

After analyzing the results of surgical treatment, depending on the length of her previous hypertension, it can be con-

cluded: the smaller the duration of the disease, the more frequently observed normalization of blood pressure, with a 

duration of hypertension is often mentioned as a significant improvement in the reduction of blood pressure numbers on 

the background of supporting antihypertensive therapy or reduce the antihypertensive drugs.

During the combined method of surgical treatment (reconstructive intervention, endovascular angioplasty and the meth-

od combining with treatment) the best effect (90%) was achieved after application vasaprostan pre- and postoperatively 

with a complete rejection of antihypertensive drugs. Results in patients with atherosclerosis better (65%) than with 

aortoarteritis (35%).

Analyzing the results of surgical treatment with combined forms RVH should be noted that our intervention confirmed 

the high efficiency single-stage phase and tactics reconstructive surgery in two or more arterial beds (endovascular 

angioplasty ) in patients with atherosclerosis immediate results are better than in patients with aortoarteritis.

Keywords:

renovascular hypertension, 

bilateral renal artery 

stenosis, surgery.

Khanchi Мead, Kospanov N.A., Demeuov T.N., Akanov E.K., Matkerimov A.Zh., 

Baubekov A.A., Zhakubayev M.A., Asratov B.I., Tergeussizov A.S.

Science senter surgery A.N. Syzganov

Ањдатпа

Вазореналды гипертензия (ВРГ) ауруына шалды??ан бас?а да бассейндерініњ за?ымдануы аралас?ан 48 нау?асты 

тексеру нєтижелерініњ, сондай-а? оларды жедел емдеудіњ тиімділігі туралы деректерініњ ретроспективтік талда-

уы жања аспектіде БА за?ымдануыныњ функционалды? мањыздылыѓын аны?тауѓа баѓытталѓан диагностикалы? 

тесттердіњ ?±ндылыѓын сипаттауѓа м‰мкіндік береді.

Оныњ гипертензияѓа дейінгі ілеспе ауруыныњ ±за?тыѓынан жедел т‰рде емдеу нєтижелері тєуелдігініњ талдауын 

жасай отырып, келесі ?орытынды жасауѓа болады: ?аншалы?ты аурудыњ созылуы аз болѓан жаѓдайда, соншалы?ты 

А? (артериялы? ?ан ?ысымы) к?рсеткіштерініњ нормада болуы бай?алады, гипертензияныњ созылу мерзімінен 

ас?ан жаѓдайда, гипотензивті терапияны ?олдайтын аясында А? сандарыныњ на?ты т?мендеуі ретінде немесе 

гипотензивті дєрі дєрмектерді ?абылдауын азайту жаѓдайы жиі д±рысталуы бай?алады. 

Хирургиялы? емдеудіњ ?±рамб?лікті тєсілін (реконструктивті хирургиялы? араласу, эндоваскулярлы? ангиопласти-

ка жєне емдеудіњ ?±рамб?лік тєсілі) ?олданѓан кезінде ењ жа?сы єсерге ?ол жеткізе алады (90%). 

Атеросклерозѓа (65%) шалды??ан аурулардыњ нєтижелері аортоартериитпен (35%) ауыратындарѓа ?араѓанда 

жа?сыра?. 

ВРГ аралас т‰рлерімен аортоартериитот дертін жедел т‰рде емдеу нєтижелерін талдай отырып, екі жєне одан да 

астам артериалды бассейндерінде реконструктивтік араласудыњ кезењ-кезењмен жєне бір сєттік тактикасыныњ 

(эндоваскулярлы? ангиопластика жєне Е простагландинмен ?исындастыру тєсілі) жоѓары тиімділігін растады,  

атеросклерозѓа шалды??ан аурулардыњ тікелей нєтижелері аортоартериитпен ауыратындардыњ нєтижелеріне 

?араѓанда айтарлы?тай д±рысыра? екендігін атап ?ткен ж?н.

Т‰йін с?здер

вазореналды  гипертензия,  

б‰йрек артериялардыњ 

екіжа?ты?  тарылуы,   

хирургиялы? емдеу

АВТОРЛАР ТУРАЛЫ

?оспанов Н±рс±лтан Айдархан±лы 

– А.Н.Сызѓанов атындагы ¦лтты? 

?ылыми Хирургия орталыѓыныњ 

?ан-тамырлар б?лімініњ мењгерушісі, 

м.ѓ.к., жоѓарѓы санаттаѓы хирург 

- дєрігер.  E-mail: kospanov.

nursultan@gmail.com 

Ханчи Миад – А.Н.Сызѓанов 

атындаѓы ¦лттык ?ылыми Хирургия 

орталыѓыныњ  ?ан-тамырлар 

б?лімініњ хирургы, м.ѓ.к., жоѓары 

санантты хирург – дєрігер 

ABOUT THE AUTHORS

Kospanov A.Nursultan – 

head of the department of 

angiosurgery, can.med., a high level 

certificate physician;

Khanchi Mead – 

surgeon of the department of 

angiosurgery, can.med., a high level 

certificate physician;

Ханчи Миад, ?оспанов Н.А., Демеуов Т.Н., Аканов Е.К., Маткеримов А.Ж., 

Баубеков А.А., Жакубаев М.А., Асратов Б.И., Тергеусизов А.С.

А.Н. Сызѓанов атындаѓы ¦лтты? ѓылыми хирургия Орталыѓы

Б‰йрек артерияларыныњ екіжа?ты? тарылуы кезіндегі вазореналды 

гипертензияны хирургиялы? емдеу

BULLETIN OF SURGERY IN KAZAKHSTAN № 1•2016

45

Аннотация

Ретроспективный анализ результатов обследования 48 больных с ВРГ в сочетании с поражением других бассей-

нов, а также данных об эффективности их оперативного лечения, позволил нам в новом аспекте характеризовать 

ценность диагностических тестов, направленных на определение функциональной значимости поражения ПА.

Проведя анализ зависимости результатов оперативного лечения от длительности предшествующей ее гипертен-

зии, можно прийти к выводу: чем меньше продолжительность заболевания, тем чаще наблюдалась нормализа-

ция показателей АД, при более же продолжительных сроках гипертензии чаще отмечалось улучшение в виде 

достоверного уменьшения цифр АД на фоне поддерживающей гипотензивной терапии или уменьшения приема 

гипотензивных препаратов.

При проведении комбинированного способа хирургического лечения (реконструктивные вмешательства, эндова-

скулярная ангиопластика и способ комбинирования с лечением) наилучший эффект (90%). Результаты у больных 

с атеросклерозом лучше (65%), чем с аортоартериитом (35%) .

Анализируя результаты оперативного лечение с сочетанными формами ВРГ следует отметить, что проведенные 

нами вмешательства подтвердили высокую эффективность поэтапной и одномоментной тактики реконструктив-

ных вмешательств на двух и более артериальных бассейнах (эндоваскулярные ангиопластики и способ комбини-

рования с простагландин Е), у больных с атеросклерозом непосредственные результаты лучше, чем у больных с 

аортоартериитом.

Ключевые слова: 

вазоренальная  

гипертензия,  двусторонние  

стеноз почечных артерий, 

хирургическое лечение

ОБ АВТОРАХ

Коспанов Нурсултан Айдарханович 

– заведующий отделением 

ангиохирургии АО ННЦХ 

им.А.Н.Сызганова. к.м.н., врач 

высшей категорий. E-mail:  

kospanov.nursultan@gmail.com 

Ханчи Миад – врач-хирург  

отделения ангиохирургии АО ННЦХ 

им.А.Н.Сызганова. 

к.м.н., врач высшей категорий.

SURGICAL TREATMENT OF RENOVASCULAR HYPERTENSION 

WITH BILATERAL RENAL ARTERY STENOSIS

 It is very complex and still debated is the ques-

tion of general and specific indications for recon-

structive surgery for patients with severe bilateral 

lesion of the Palestinian Authority and with the de-

feat of the only functioning kidney arteries.

 Malignant hypertension for the majority of 

these patients, and the possibility of renal failure in 

the case of an unsuccessful reconstruction signifi-

cantly increases the risk of surgery. Several authors 

(AV Pokrovsky, A. Spiridonov; Foster et al., 1973) 

is considered to make surgery in stages, we do be-

lieve it is necessary to produce the two-stage cor-

rection of abnormal renal arteries (R.A).

Material and methods. With 2000 то 2010, 

Department of Vascular Surgery Syzganov ob-

served 270 patients with symptomatic hypertension 

caused by renovascular hypertension (RVH).

 The main etiological factors in this process are: 

atherosclerosis, nonspecific aortoarteriit PA. Of 

these, stenosis of both renal arteries are 48 cases 

of 20 with atherosclerotic etiology, 28 patients with 

aortoarteritis .

 Surgical treatment of bilateral lesions depends 

on the general condition of the patients and accom-

panying whitening, and when combined with Leriche 

syndrome and aortic aneurysm requires one-stage 

reconstruction of the R.A and the abdominal aorta. 

When combined lesions of the R.A and the aortic 

arch branches made 14 surgeries in this group of 

Figure 1 

Angiogram. aortoarteritis. 

Stenosis of abdominal 

aorta in the infrarenal 

section. King King of the 

abdominal aorta. Reno-

vascular hypertension. 

Occlusion of both renal 

arteries

patients. Reconstructive surgery aimed not only at 

eliminating systemic hypertension, but also to re-

store regional blood circulation disorders. In this re-

gard, the correct definition of treatment policy and 

related issues with her choice of surgical interven-

tion, surgical approaches and methods of correc-

tion of disorders of blood circulation in the different 

vascular territories is of paramount importance.

The choice of surgical tactics in the reconstruc-

tion of the renal artery

 Against the background of atherosclerosis are 

the main options for reconstruction after aortic 

Ханчи Миад, Коспанов Н.А., Демеуов Т.Н., Аканов Е.К., Маткеримов А.Ж., 

Баубеков А.А., Жакубаев М.А., Асратов Б.И., Тергеусизов А.С.

Национальный научный Центр хирургии им. А.Н. Сызганова

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