1. Introduction

Repeated body mass gain (BMI) after bariatric surgeries remains one of the leading causes of a decrease in the long-term surgical effectiveness of obesity and associated metabolic disorders, as confirmed by data from modern domestic and foreign studies [2,3,5,6]. The lack of a unified approach to assessing the risk factors for repeated gain of body weight and choosing the optimal surgical tactics necessitates the variability of clinical outcomes and the increase in the number of repeated interventions [1,4].

Purpose of the research. Algorithmized approach to preventing repeated weight gain after bariatric surgeries.

2. Research Material and Methods

The study is based on a retrospective analysis of the results of surgical treatment of 1457 patients with obesity who underwent bariatric surgery in the period 2022-2025 at specialized surgical centers.

Depending on the treatment-diagnostic and surgical tactics used, all patients were divided into two groups:

- comparison group - 710 patients who used the traditional approach without differentiating the risk of repeated gain of body weight;

- the main group consisted of 747 patients, whose treatment was carried out using optimized tactics based on algorithms for assessing risk factors and individualizing surgical parameters.

The study included patients with morbid and high-degree obesity, including in combination with type 2 diabetes mellitus (type 2 DM). Exclusion criteria were repeated bariatric surgeries in the medical history, pronounced mental disorders, and non-compliance with recommendations in the early postoperative period.

All patients underwent standard bariatric interventions, including longitudinal gastric resection and single-anastomous gastric bypass grafting. In the main group, the surgical parameters (calibration probe diameter, alimentary loop length) were selected individually, taking into account the initial degree of obesity, the presence of metabolic disorders, and the suspected risk of repeated weight gain.

Repeated body mass gain was assessed based on the dynamics of body weight and body mass index in long-term observations. RMPT was understood as a clinically significant increase in body weight after reaching the minimum post-operative weight. An assessment of the risk factors for RMPT, the frequency of repeated surgical interventions, the structure and frequency of immediate postoperative complications, as well as the effectiveness of conservative treatment, was conducted.

During examination, diagnosis, preoperative preparation, selection of bariatric surgical intervention methods, and postoperative management of patients with Graves' disease, it was carried out according to the generally recognized latest clinical recommendations, which were adopted and approved by the Ministry of Health of our Republic. Statistical processing of data was carried out using standard descriptive statistics methods. Quantitative indicators are presented as absolute values and percentages.

3. Results and Their Discussion

RMPT was detected in 305 out of 1457 patients (21.0%). At the same time, the frequency of RMPT significantly differed between the studied groups (Table 1).

Table 1. Frequency of RMPT in the studied groups

As can be seen from Table 1, in the main group, the frequency of RMPT decreased by 19.1% compared to the comparison group, which corresponds to a decrease in the number of cases per 131 patients (relative decrease ≈ 62%).

Analysis of the clinical and metabolic characteristics of patients allowed us to identify a number of factors reliably associated with the development of RMPT. The most significant of these were the high initial degree of obesity (BMI ≥ 50 kg/m2), the presence and duration of type 2 diabetes mellitus, the irrational choice of surgical technique parameters, and the absence of systematic postoperative monitoring (Table 2).

Table 2. Main risk factors for RMPT

In the comparison group, these factors were more often combined, which led to a higher frequency of RMPT.

All patients with RMPT initially underwent conservative therapy, including dietary correction and medication support (Table 3).

Table 3. Results of conservative treatment of RMPT

As can be seen from Table 3, in the main group, the effectiveness of conservative treatment was higher by 26.9% (in the comparison group - 29.4%, in the main group - 56.3%), which significantly reduced the number of patients requiring repeated operations.

Repeated operations were required for 192 patients, and their frequency differed significantly between the groups.

Table 4. Frequency of repeated operations

As can be seen, the use of an optimized tactic made it possible to reduce the frequency of repeated operations by 16.6% - 116 cases (in the comparison group - 21.7%, in the main group - 5.1%).

The immediate complications after repeated operations are presented in Table 5.

Table 5. Repeated intervention complications

As can be seen from Table 5, the frequency of immediate postoperative complications in the main group decreased by 10.8% (in the comparison group - 26.6%, in the main group - 15.8%), which indicates an increase in the safety of the optimized surgical tactics.

Thus, the implementation of an algorithmized approach based on assessing the risk factors for PMMT and individualizing surgical tactics has significantly reduced the frequency of repeated body weight gain, reduced the need for repeated operations, and improved immediate surgical results.

Discussion of the results. The obtained results confirm that body PRMT after BOD is a multifactorial process, in the development of which both the initial clinical and metabolic characteristics of patients and the features of the applied surgical tactics play a key role. The high frequency of PMMT in the comparison group (30.7%) indicates the limitations of the traditional approach based on the unified selection of surgical parameters without taking into account individual risk.

Of particular importance is the identified relationship between the development of premature birth defects and the high initial degree of obesity, the presence of type 2 diabetes mellitus, and the absence of systemic postoperative monitoring. The obtained data indicate the need for a personalized approach to bariatric treatment. The implementation of optimized treatment, diagnostic, and surgical tactics has significantly improved clinical results. The decrease in the frequency of PMMT to 11.6%, the reduction in the number of repeated operations to 5.1%, and the reduction in the frequency of immediate complications to 15.8% indicate the clinical effectiveness and safety of the proposed approach.

4. Conclusions

Thus, the use of optimized therapeutic, diagnostic, and surgical tactics made it possible to significantly reduce the frequency of PMMT after BOD from 30.7% to 11.6% (a decrease of 19.1%). The algorithmized approach ensured a decrease in the frequency of repeated operations from 21.7% to 5.1% (16.6% decrease) and a decrease in the frequency of immediate postoperative complications from 26.6% to 15.8% (10.8% decrease), which confirms its clinical advantage compared to traditional tactics.