Bakhtiyar Yelembayev

Background: The FundoRing modification of one-anastomosis gastric bypass (OAGB) has demonstrated superior clinical outcomes compared with standard OAGB in patients with metabolic syndrome. However, the cost-effectiveness of this innovative technique remains unclear. This study aimed to perform a cost-effectiveness analysis of FundoRing versus standard OAGB using the incremental cost-effectiveness ratio (ICER) and the cost-effectiveness plane. Methods: A cost-effectiveness analysis was conducted alongside a randomized controlled trial including 1000 patients ( n = 500 FundoRing, n = 500 standard OAGB) with metabolic syndrome and up to 3 years of follow-up (median: 28 months, IQR: 22–34 months). Effectiveness was measured as the proportion of patients who achieved a target BMI of 2 at their last follow-up visit. Direct medical costs, including surgical intervention, hospitalization, postoperative follow-up, and management of late complications, were calculated from the healthcare-system perspective. Costs were converted from the Kazakhstani tenge (KZT) to US dollars (USD) using the 2025 exchange rate (521.59 KZT/USD). The willingness-to-pay (WTP) threshold was used as a contextual benchmark, with the understanding that the primary conclusion on cost-effectiveness relies on the dominance finding. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs divided by the difference in effectiveness. A probabilistic sensitivity analysis with 5000 bootstrap iterations was performed to construct the cost-effectiveness plane. Results: At the last follow-up (median 28 months), the FundoRing group demonstrated significantly higher effectiveness (94.2% vs. 86.7% achieving BMI 2 ; P = 0.002) and significantly lower total costs per patient (5928.10 USD vs. 6758.00 USD, difference −829.90 USD, 95% CI: −1184.2 to −475.6). The cost savings in the FundoRing group were primarily driven by a reduced incidence of late complications such as dumping syndrome (13.7% vs. 36.5%; P < 0.001), marginal ulcers (0.2% vs. 2.9%; P < 0.001), and bile reflux esophagitis (0.2% vs. 8.1%; P < 0.001). The ICER was −11 065 USD per patient achieving the target BMI. On the cost-effectiveness plane, 100% of the bootstrap iterations fell in the southeast quadrant, indicating that FundoRing is a dominant strategy (lower costs and higher effectiveness). Conclusion: FundoRing modification of OAGB is a more cost-effective strategy than standard OAGB within the studied population and single-center setting. The reduction in late postoperative complications generates substantial healthcare savings while achieving superior clinical outcomes. These findings provide economic evidence to support the use of the FundoRing technique in bariatric surgery. Multi-center studies are needed to confirm generalizability.

Background/Objectives The FundoRing gastric bypass method has suggested improved antireflux effects after one year of follow-up compared to standard one-anastomosis gastric bypass (OAGB). However, longer-term impact on adverse effects remains unclear. This study aimed to compare three-year outcomes of reflux esophagitis and other late postoperative complications between the FundoRing method and standard OAGB. This manuscript presents a pre-specified secondary analysis of these endpoints from a single-center RCT. This article is structured as an original research report with detailed technical description and exploratory secondary outcome analysis. Methods This was a single-center, prospective, interventional, open-label randomized controlled trial (FundoRing Trial) with a 3-year follow-up period. The registered primary endpoint was weight loss; the present analysis focuses on pre-specified secondary endpoints: assessment of reflux esophagitis and other late postoperative complications. Results Overall, 1000 patients (n = 500 per group) were randomized and included in the intention-to-treat analysis. Three-year follow-up rates were 83% in the f-OAGB group and 87% in the s-OAGB group. There were no deaths in either group. The DeMeester index 3 years after surgery was significantly lower in the f-OAGB group (3.97 ± 1.8 vs. 7.2 ± 7.4; difference 3.23; 95% CI: 1.82–4.64; p < 0.001). At 3-year follow-up, f-OAGB was associated with significantly lower rates of dumping syndrome symptoms, marginal ulcer incidence, and other late complications compared to s-OAGB. Conclusions This trial compared two composite techniques that differ in both fundoplication and gastric pouch length (10 cm in f-OAGB vs. 15–18 cm in s-OAGB). Within this context, three-year follow-up of the FundoRing method compared to standard OAGB suggests improved results on 24-hour pH impedance monitoring and a reduction in several late complications, including bile reflux esophagitis, marginal ulcers, and dumping syndrome. However, due to the structural confounding between fundoplication and pouch length, causal attribution of these benefits to the fundoplication alone is not possible. Clinically, f-OAGB may be considered for patients at high risk for bile reflux, but further validation is required. The findings should be interpreted as exploratory. Further multicenter studies with standardized pouch volumes are needed to disentangle the individual contributions of each technique component and to establish the generalizability of these results.

Objective: To compare the 3-year quality of life, weight loss, comorbidity remission, and complication rates between FundoRing One-Anastomosis Gastric Bypass (f-OAGB) and standard OAGB (s-OAGB) in patients with obesity. Background: While OAGB is an effective metabolic procedure, it is associated with specific complications like bile reflux and marginal ulcers. The FundoRing modification, involving total fundoplication of the excluded stomach, may mitigate these risks. Long-term, patient-centered outcomes measured by the Bariatric Analysis and Reporting Outcome System (BAROS) are crucial. Methods: In this single-center, prospective randomized trial, 1000 patients (BMI 30-50 kg/m²) were assigned 1:1 to f-OAGB (n=500) or s-OAGB (n=500) between January 2021 and December 2024. A detailed CONSORT flow diagram guided the study. Randomization was performed by a statistician using sequentially numbered opaque envelopes. Outcome assessors were blinded. The primary outcome was the total BAROS score at 3 years. Safety was assessed using structured criteria, including 30-day and late complications (Clavien-Dindo classification). Results: At 3 years, follow-up was 83.0% (415/500) for f-OAGB and 87.0% (435/500) for s-OAGB (reasons for attrition: lost to follow-up, protocol violations, withdrawal of consent). The f-OAGB group demonstrated a significantly higher total BAROS score (5.59±1.13 vs. 4.57±1.09; mean difference 1.02, 95% CI 0.87–1.17; p<0.001), indicating a "very good" vs. "good" outcome. f-OAGB resulted in superior %EWL (84.3±12.1% vs. 76.8±14.3%; p<0.001), greater improvement in medical conditions, and better quality of life. No intraoperative, 30-day, or late mortality occurred in either group during the 3-year follow-up period (overall mortality 0%). f-OAGB was associated with significantly lower rates of bile reflux (0.2% vs. 9.4% at 3 years, p<0.001), marginal ulcers (0.2% vs. 3.4% at 3 years, p<0.001), and dumping syndrome (13.7% vs. 36.5% at 3 years, p<0.001). Conclusions: At 3 years post-surgery, FundoRing OAGB is superior to standard OAGB in achieving better overall health outcomes as measured by the BAROS score. It provides enhanced weight loss, greater comorbidity resolution, and superior quality of life, while significantly reducing the risk of bile reflux, marginal ulceration, and dumping syndrome. F-OAGB represents a safe and effective technical advancement in metabolic surgery.

Background. Staple line leak after sleeve gastrectomy remains one of the least predictable complications in bariatric surgery. Despite numerous proposed explanations, no consensus pathogenetic model exists. Objective. To develop a biomechanical model accounting for the mechanism of staple line failure after sleeve gastrectomy. Model. The present work proposes the formula: Leak = Obstruction & "Dog Ear". Leak is posited to be the predictable consequence of two co-occurring conditions: (1) mechanical or functional obstruction generating excess intraluminal pressure in the proximal gastric sleeve, and (2) a "dog ear" — a residual triangular pouch at the angle of His acting as a gas-and-fluid trap that prevents pressure decompression into the esophagus. Neither factor alone is sufficient: isolated obstruction results in stenosis; an isolated “dog ear”, in the absence of elevated pressure, remains clinically inconsequential. Conclusion. The formula Leak = Obstruction & "Dog Ear" offers a reproducible biomechanical framework for understanding and preventing staple line failure after sleeve gastrectomy. Prospective experimental investigation is required.

Objective. To analyze the results of single-anastomosis gastric bypass surgery using the FundoRing method in obese patients with ASA 1—2 status in a substitutive inpatient setting compared to a 24-hour inpatient setting. Material and methods. A prospective, open-label, randomized clinical trial (RCT) was conducted at two private surgical centers serving as the clinical base for Astana Medical University in Astana, Kazakhstan. Between July 2024 and February 2025, 157 single-anastomosis gastric bypass procedures using the FundoRing method were performed; of these, 113 patients met the inclusion criteria. All patients in the RCT were randomized using identical sealed envelopes into two parallel groups. Group 1 included 57 patients who underwent surgery on a day surgery unit, while Group 2 included 56 patients who underwent surgery on a 24-hour inpatient unit. Results. The median follow-up was 6 months. There were no deaths or clinically significant complications in either group. There were no conversions from laparoscopic to open surgery. There were 54 women (94.7%) in Group 1 and 48 women (85.71%) in Group 2. The average age was 37±2.7 and 40±3.2 years in groups 1 and 2, respectively (p=0.7). Preoperative body mass index was 38.12±8.0 kg/m2 in group 1 and 40.95±9.0 kg/m2 in group 2 (p=0.62). Postoperative body mass index was 25.9±3.87 and 26.6±3.8 kg/m2, respectively (p=0.43). The duration of surgery in group 1 was 105±6.7 min, and in group 2, 96±8.7 min (p=0.7). The hospital stay was 1±0.09 days in group 1 and 3.84±0.5 days in group 2 (p=0.03). The patient’s hospital stay in Group 1 was 121.000±40.9 rubles compared to 183.000±55.2 rubles in Group 2 (p=0.02). Conclusion. The main outcomes of single-anastomosis gastric bypass using the FundoRing method in obese patients with ASA 1—2 status, operated on inpatient versus outpatient basis, were similar, with the exception of a shorter length of stay and lower overall hospital stay costs in the outpatient setting.

Introduction: Bariatric surgery, particularly one-anastomosis gastric bypass (OAGB), is one of the most effective treatments for morbid obesity. However, postoperative reflux esophagitis remains a significant concern. To enhance the antireflux effect, a modified technique FundoRing was developed. Aim. To perform preoperative and postoperative endoscopic evaluation of the upper gastrointestinal tract in patients after OAGB and to analyze the preventive effect of the FundoRing modification on postoperative reflux esophagitis. Materials and Methods: A single-center, prospective, interventional, open-label randomized controlled trial was conducted. The main group underwent FundoRing-OAGB (f-OAGB, n=500), and the control group underwent standard OAGB (s-OAGB, n=500). All patients had pre- and postoperative endoscopic assessment of the esophagogastric junction, gastric pouch, and gastroenterostomy. Results: Endoscopic evaluation demonstrated hiatal hernia in 32% of patients in the f-OAGB group and 24% in the s-OAGB group. Preoperative identification of hiatal hernia without signs of gastroesophageal reflux disease was challenging and was detected in only 9.6–10.4% of cases. Preoperative reflux esophagitis was diagnosed in 21.6% (f-OAGB) and 11.6% (s-OAGB). Postoperatively, reflux esophagitis occurred in only 1% of the f-OAGB group versus 11.6% of the s-OAGB group, indicating a stronger antireflux barrier with the FundoRing technique. Mean gastric pouch volume under light insufflation was approximately 50 ml. The gastroenterostomy diameter measured 30–35 mm intraoperatively and 20–25 mm at 3-year follow-up. Conclusion: Pre- and postoperative endoscopic evaluation showed advantages of the FundoRing modification of OAGB, particularly its preventive effect against postoperative gastroesophageal reflux disease and stable anatomical outcomes. Введение: Бариатрическая хирургия, в частности одноанастомозное желудочное шунтирование (ОАГШ), является одним из наиболее эффективных методов лечения морбидного ожирения. Однако развитие послеоперационного рефлюкс-эзофагита остаётся актуальной проблемой. Для усиления антирефлюксного эффекта был разработан модифицированный метод ФундоРинг. Цель. Дооперационная и послеоперационная эндоскопическая оценка верхних отделов желудочно-кишечного тракта у пациентов после выполнения одно анастомозного желудочного шунтирования. Проанализировать эффект превентивного воздействия разработанного метода ФундоРинг на развитие послеоперационного рефлюкс-эзофагита. Материал и методы: Проведено одноцентровое, проспективное, интервенционное, открытое рандомизированное контролируемое исследование. В первой основной группе выполнено одноанастомозное гастрошунтирование по методу ФундоРинг (ф-ОАГШ n=500). Операцией в контрольной группе была стандартное одноанастомозное гастрошунтирование (с-ОАГШ n=500). Всем пациентам проведено до и послеоперационная эндоскопическая оценка пищеводно-желудочного перехода, малого желудочка и гастроэнтероанастомоза. Результаты: В результате эндоскопического обследования выявлено, что процент грыж пищеводного отверстия диафрагмы (ГПОД) у пациентов с ожирением составляет 32% в группе ф-ОАГШ и 24% в группе с-ОАГШ. При этом дооперационная диагностика ГПОД без гастроэзофагеальной рефлюксной болезни (ГЭРБ) у пациентов с ожирением была затруднена и процент выявления ГПОД составил в двух группах от 9,6 % - 10,4 %. До операции рефлюкс – эзофагит диагносцирован в 21,6% в первой группе и в 11,6% во второй группе. После операции отмечена существенная разница в выявленном послеоперационом рефлюкс – эзофагите в группе ф-ОАГШ с фундопликацией, где он составил всего 1% против 11,6% в группе с-ОАГШ без фундопликации. Эндоскопическое измерение размеров малого желудочка, при легкой инсуфляции воздухом составлял в среднем 50 мл. Интраоперационно гастроэнтероанастомоз составлял 30–35 мм в диаметре, а через 3 года размер гастроэнтероанастомоза оценивался в диапазоне от 20 до 25 мм. Выводы: До и послеоперационная эндоскопическая оценка желудочного шунтирования по ФундоРинг выявила преимущество разработанного метода одно...

Outpatient surgery means that the patient patient has surgery and often goes home on the same day. Safety and utilization outcomes were similar between out

Background Compared to Roux-en-Y gastric bypass, cases of dumping syndrome (DS) occur significantly less frequently after one anastomosis gastric bypass due to the longer gastric pouch. Recent studies have proposed supplementation of gastric bypass with modified fundoplication using the excluded part of the stomach; however, only a few cases have been reported, as this is often performed in revision surgeries. This study aimed to compare the incidence of early and late DS after “FundoRingOAGB” and standard one anastomosis gastric bypass by assessing the OGTT, insulin levels, and Sigstad scores as outcome measures. Materials and Methods This was a single-center, prospective, interventional, open-label (no masking) RCT (FundoRing Trial) with a 1-year follow-up period. The endpoints were oral glucose tolerance tests (OGTT), insulin levels, Sigstad scores, early and late DS symptoms. Results Overall,1000 patients (n=500 FundoRing One-anastomosis gastric bypass [f-OAGB] vs. n=500 standard OAGB [s-OAGB]) with complete follow-up data were included in the study. No leaks, bleeding, or mortality occurred in either group. At 1-year, BMI in the f-OAGB group was 27.0 ± 0.75 vs. 29.0 ± 0.66 s-OAGB group (p=0.04). DS symptoms were observed in 98 (19.6%) and 175 (35%) patients in the f-OAGB and s-OAGB groups, respectively (P =0.001). Sigstad’s scores for the f-OAGB and s-OAGB groups were 2.8 ± 0.9 and 5.1 ± 1.3, respectively (p=0.001). Conclusion Modified fundoplication of the OAGB-excluded stomach significantly decreased early and late DS symptoms more effectively than standard OAGB at 1 year.

The highly effective one-anastomosis gastric bypass (OAGB) is one of the most widely performed procedures in bariatric/metabolic surgery. However, concerns

Введение: Одноанастомозное желудочное шунтирование (ОАГШ) является широко применяемой бариатрической и метаболической операцией, демонстрирующей высокую эффективность и относительно низкий уровень осложнений. Однако послеоперационный билиарный рефлюкс остается значимой проблемой. Для её решения Оспановым О. разработан ОАГШ по методу ФундоРинг, включающий формирование фундопликационной манжетки вокруг желудочного пауча из отключенной части желудка. Цель: Оценить отдалённый антирефлюксный эффект метода ФундоРинг по сравнению со стандартизированным ОАГШ с использованием суточной pH-импедансометрии через ≥36 месяцев после операции. Методы: Настоящее исследование представляет собой проспективное одноцентровое подисследование в рамках рандомизированного контролируемого испытания «The FundoRingOAGB Versus Non-wrapping (Non-banded) Standard Method of Laparoscopic One Anastomosis Gastric Bypass (FundoRingMGB)» (NCT04834635). В анализ включено 259 пациентов: 131 после ОАГШ по методу ФундоРинг (ф-ОАГШ) и 128 после стандартизированного ОАГШ (с-ОАГШ). Всем пациентам проведена 24-часовая pH-импедансометрия через ≥36 месяцев после операции. Основными конечными точками были: время экспозиции кислоты в пищеводе, количество эпизодов кислотного, слабокислого и щелочного рефлюкса, а также показатель DeMeester. Результаты: Через ≥36 месяцев в группе ф-ОАГШ отмечены достоверно меньшие значения времени кислотной экспозиции (1,05 ± 0,6% против 1,85 ± 1,1%; p<0,001), числа эпизодов кислотного рефлюкса (5,01 ± 4,1 против 9,3 ± 7,8; p<0,001), слабокислого рефлюкса (31,47 ± 14,1 против 39,64 ± 23,1; p<0,001) и щелочного рефлюкса (1,35 ± 0,4 против 5,61 ± 5,3; p<0,001). Средний показатель DeMeester также был достоверно ниже в группе ф-ОАГШ (3,97 ± 1,8 против 7,2 ± 7,4; p<0,001). Заключение: ФундоРинг ОАГШ продемонстрировал более выраженный отдалённый антирефлюксный эффект по сравнению со стандартизированным ОАГШ. Данная модификация эффективно снижает как кислотный, так и некислотный рефлюкс, обеспечивая дополнительную защиту от послеоперационного гастроэзофагеального рефлюкса. Для окончательной валидации полученных данных требуются дальнейшие многоцентровые исследования.