Meet the Expert
Dr. Sergey Aleksandrovich Kachurin is an experienced board-certified surgeon specializing in bariatric surgery. He's a member of the Russian Society of Bariatric Surgeons and IFSO.
Education and Qualifications
2001 – Pirogov Russian National Research Medical University, General Medicine
2003 – Surgical residency, Russian Medical Academy of Postgraduate Education (RMAPO)
2006 – Surgical fellowship, RMAPO at Botkin City Clinical Hospital
Continuing Education
2001–2013 – Multiple courses in general, endoscopic, and thoracic surgery, surgical endocrinology, and minimally invasive techniques
2018 – Professional retraining in coloproctology (State Scientific Centre of Coloproctology named after A.N. Ryzhikh)
2020 – Professional retraining in oncology (Pirogov Russian National Research Medical University), awarded «Moscow Physician» status and highest qualification category.
Professional Experience
Dr. Kachurin has over 24 years of surgical experience.
He's performed more than 10,000 gastrointestinal surgeries, including emergency, oncologic, and bariatric procedures.
Specialties: General surgery, bariatric surgery, and treatment of stomach, colon, and rectal tumors.
Surgical Expertise
Open surgeries: Pleural cavity drainage, thoracotomy, lung resections, gastric resections, small and large bowel resections, operations for pancreatic necrosis, hernia repairs, soft tissue tumor removal, treatment of infections and inflammation, and reconstructive procedures.
Laparoscopic surgeries: Appendectomy, cholecystectomy, resections of the stomach, pancreas, liver, small and large bowel, sleeve gastrectomy, all types of gastric bypass, revisional bariatric surgery, GERD and hiatal hernia repair, laparoscopic pelvic prolapse correction, and abdominal wall hernia repair.
Understanding Bariatric Surgery
Bariatric surgery is highly effective for treating obesity, especially when patients have other health conditions. Obesity dramatically increases your risk of type 2 diabetes, high blood pressure, heart disease, metabolic syndrome, fatty liver disease, and certain cancers. These risks often stem from a mix of factors: genetics, metabolic issues, a sedentary lifestyle, and poor diet.
But obesity isn't just about physical health. It's closely tied to social inequality and can seriously impact quality of life. Patients face a much higher risk of depression, anxiety, and social isolation. This creates a vicious cycle: emotional stress triggers disordered eating, which makes everything worse.
Research shows that bariatric surgery delivers significant, lasting weight loss. Even better, many patients see major improvements, or even complete resolution, of conditions like type 2 diabetes, high blood pressure, and cholesterol problems.
Main Types of Bariatric Surgery
The major procedures include various forms of gastric bypass (like the classic Roux-en-Y), mini gastric bypass, biliopancreatic diversion, sleeve gastrectomy (vertical sleeve gastrectomy), adjustable gastric banding, and intragastric balloon placement. These surgeries help patients achieve substantial, sustained weight loss and often improve or eliminate related health problems. However, adjustable banding and balloon placement are rarely used today due to limited effectiveness and side effects.
Why I Chose Bariatrics
Before focusing on bariatric surgery, I performed operations on all parts of the gastrointestinal tract and spent years in surgical oncology. I worked primarily on colon, rectal, and gastric cancer cases. That's where my journey started.
I made the switch because I hate standing still. I essentially operated on everything. As I saw fewer oncology cases, I learned to operate on the esophagus, hiatal hernias, the diaphragm, reflux disease, and the pelvic floor. There were always plenty of patients, so I kept learning.
The more I studied bariatric surgery, the clearer it became that surgical oncology follows relatively standardized techniques. The main differences are the specific tumors and treatment approaches. But bariatric surgery? It's not just surgery. It's a comprehensive field that brings together surgery, endocrinology, nutrition, psychology, and the social aspects of human life. The deeper you dive in, the more questions emerge.
I love being at the forefront of change and being part of history.
Russia doesn't have many full-fledged bariatric centers, even though plenty of people want to work in this field. Open any social media platform and you'll immediately see ads from bariatric surgeons. Yet there aren't even 15–20 world-class bariatric surgeons in the country who have the advanced qualifications to perform the full spectrum of operations. In most cases, these specialists mainly perform sleeve gastrectomy, the most common operation here. This reflects a real shortage of surgeons skilled in all types of bariatric procedures.
We're reaching a new level of organization. We're not just performing surgeries anymore: we're analyzing results, building registries, and planning large-scale studies.
For example, we're launching a multicenter study on body composition in patients before bariatric surgery right now. Over three years, we plan to enroll 25,000–30,000 cases and track their health at five and ten years. This study will help us identify factors that predict complications in the long term and choose the safest, most effective operation for each individual patient. We'll also assess how different surgical methods affect bone health, muscle loss (sarcopenia), and overall quality of life.
Looking at the Russian Bariatric Registry, even patients over 60 mostly get sleeve resections and bypasses, about 180 and 150 operations last year, respectively.
Bariatric surgery types vary dramatically around the world. Some places favor classic bypasses, others prefer mini-bypasses or biliopancreatic diversion. This raises a question: Are people on different continents really that different? Or is it just about different surgical schools and preferences? I lean toward the latter.
«Our Patients Are as Fragile as Crystal»
According to Russian clinical guidelines, surgical treatment is recommended for people with grade 2 obesity who have related diseases, and especially for those with grade 3 obesity. But we can evaluate any patient aged 18–60. Just evaluate them. The patient's mind needs to be «ready» for surgery. Without that readiness, nothing will work. That's where I trust psychologists and psychiatrists. Bariatrics isn't the easy way out. First and foremost, it's about motivation.
A person doesn't just come in for surgery and leave. We track their motivation and commitment, and we support them through every stage: repeat hospitalizations, cardiology monitoring, and treatment recommendations. If they need a specialist, say, a sleep doctor for obstructive apnea, we don't just hand them a referral. We assign them to a specific physician, stay in contact with that doctor, and get feedback on treatment.
So when I started practicing bariatrics, I immediately built a team — on top of all the required specialists listed in regulations. We have an endocrinologist, cardiologist, psychologist, psychotherapist, and geriatrician.
All our operations are minimally invasive, laparoscopic. That's what sets us apart from general surgery. We understand the people we work with: size doesn't matter, because our typical patient is actually as fragile as crystal.
When it comes to selection criteria, it's important to understand this: before age 60, aesthetic concerns often dominate: eating disorders, a sedentary lifestyle, the habit of spending evenings at home instead of staying active. After 60, it's a completely different story. These are truly suffering people: barely mobile, with grade 3 obesity or super obesity, with destroyed joints and spines. A vicious cycle develops, pain limits movement, which worsens obesity. This isn't about looks anymore. It's about preserving life and quality of life.
There's also a special group of patients with sarcopenic obesity, where body composition changes and muscle mass decreases. Working with these patients is especially challenging. We need new approaches and operation types, and we're actively developing them now.
Of course, there are individual cases. For example, I had a patient with a BMI of 29. Technically, that's not an indication for surgery. But over 10 years, she tried medications six times, and her weight fluctuated by 50 kilograms. Ultimately, it was a well-justified decision.
There was another case where surgery was performed at a BMI of 24.5. That decision took a long time and only happened after a comprehensive workup, multiple consultations, and discussion at a multidisciplinary conference. These operations are performed in global practice too. Everything depends on the specific situation and whether the patient has exhausted all conservative options.
Choosing the Right Treatment
Russian bariatric surgeons use all modern methods to assess body composition before surgery. For example, a DXA scanner lets us non-invasively examine body composition and bone structure in just 10 minutes. We assess fat levels, muscle mass, bone health—everything. This helps us choose the optimal operation for each patient, especially elderly patients, to minimize the risk of muscle loss and bone problems (osteoporosis and osteopenia).
Methods of Assessing Body Composition and Preparing Patients Before Bariatric Surgery
Russian centers use the same technologies and treatment methods as facilities abroad. Completely new techniques are also emerging, like endoscopic gastroplasty. This is a minimally invasive procedure where the stomach is reduced without any incisions or tissue removal. An endoscope is inserted through the mouth, just like during a regular endoscopy, and the surgeon places sutures directly inside the organ.
The FDA approved this method in 2022, and it's already being used in Russia. Unlike surgical sleeve resection, the stomach stays intact, and the risk of developing gastroesophageal reflux disease is much lower. The procedure takes about an hour and is performed under sedation, meaning without intubation or general anesthesia, and recovery is quick. Doctors Mikhail Vyborny at Ilyinsky Hospital and Rashid Askerkhanov at Loginov Moscow Clinical Scientific Center and EMC have been performing this procedure since this year.
I consider the diagnostic stage crucial for choosing the right treatment method. That's why I've integrated DXA scanning into my practice. It allows us to non-invasively examine body composition and bone structure in just 10 minutes. We assess fat levels, muscles, bone health, everything. This helps us select the optimal operation for each patient, especially elderly patients, to minimize the risk of muscle loss and bone problems down the road.
Clinical conditions and how we organize treatment also matter. For example, people appreciate that we can do everything «turnkey». The patient arrives and is admitted the next day. All tests and preoperative evaluations happen right here, no unnecessary hassle or searching for hotels. After surgery, we recommend staying in Moscow for at least a week to recover comfortably under observation.
Some people are comfortable staying longer; others leave earlier, it's all individual. We stay in constant contact with the patient, monitor their condition, and provide online consultations. For many, this is a deciding factor: fast, organized, no bureaucracy, and full support.
What Else You Should Know About Surgery (FAQ)
How long is the hospital stay after surgery?
On average, hospitalization after bariatric surgery lasts two days. On the first day after surgery, the abdominal drain is usually removed after an ultrasound confirms there's no fluid buildup or other complications. On the second day, we perform oral contrast radiography to check how the stomach is functioning and to verify the integrity of the newly created gastric pouch.
How do recovery and nutrition work after surgery?
For the first three days after surgery, you're allowed water on a strict schedule: one sip every five minutes, then one sip every ten minutes. It's important to drink the right amount per day, but drinking more isn't allowed. After three days, you can start adding jello, compote, fruit drinks, kefir, drinkable yogurt, protein shakes, tea, coffee, and diluted juice.
After two weeks, you can eat anything with a consistency similar to baby food. After two months, you can essentially eat anything, but your portion size stays at 100 ml for life.
When can I return to physical activity?
For the first two months, it's strictly prohibited. We're changing how your digestive system works and how you absorb nutrients. Adding exercise stress during this time is a bad idea, your body will think it's under attack. After two months, though, you need to hit the gym, exercise, and build muscle. Elderly patients should focus on walking more, moving more, and returning to normal life.
Do medications like semaglutide help avoid surgery?
These medications do produce good results, reducing weight by 10–20%. But the effect only lasts while you're taking the injections. Stop, and the weight comes back.
Plus, a year-and-a-half course of these medications costs roughly the same as the surgery itself. According to statistics, only about 20% of patients maintain their weight after medical therapy. So most people eventually choose surgery, it's just a matter of time.
Are there risks of complications?
What matters isn't whether complications exist, but how the surgeon manages them. In bariatric surgery, the risk of serious complications is about 1–1.5% globally. Today, bariatric surgery is considered one of the safest surgical fields.
We have everything we need to handle any situation quickly and safely: experience, a dedicated team, 24-hour intensive care, and proven medical supplies.
What are the contraindications for surgery?
We don't perform surgical treatment for obesity if patients have severe mental disorders, uncontrolled endocrine diseases, severe heart, kidney, or liver failure, active cancer, or alcohol or drug dependence. Contraindications are determined individually after a medical evaluation, based not only on test results but also on the person's internal readiness for change.