الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The comorbidities associated with obesity are responsible for more than 2.5 million deaths per year worldwide. Bariatric surgery is effective in providing weight loss of large magnitude, correcting comorbidities and decreasing overall mortality, providing a survival advantage. Bariatric surgery showed an increased morbidity and mortality in male and super-super-obese patients. To reduce complications and mortality, SG was pioneered during the past decade as the first operation of a 2-stage intervention for super and super-super obesity [BMI, kg/m2 50 and 60] and/or high operative risk as a strategy to minimize morbidity and mortality. Our study was to evaluate laparoscopic sleeve gastrectomy as a one-stage bariatric procedure for weight loss in morbidly obese patients regarding; outcomes of excess weight loss, changes in comorbidities; (hypertension, diabetes mellitus and hyperlipidaemia), and the complication rates. The study included 20 patients; 16 (80%) females and 4 (20%) males. The procedure of SG involves resection of the gastric fundus, the predominant part of the stomach in the production of ghrelin, resulting in less stimulation of the hunger center and better weight loss than gastric banding. Our technique of SG does not include reinforcement or the use of buttressing material and, in our study, no early postoperative leakage was reported. Late postoperative leakage was reported in 1 patient. Although incidence of anastomotic leak is relatively low in SG, 2.7% (0% to 20%), its potential to increase morbidity, length of hospital stay, and mortality is great, and there is no agreed standard procedure for leak prevention. In our study, LSG showed to be an effective procedure that has a sustained adequate EWL. EWL% (for the 20 patients) reached up to 65.87 ± 7.54% at the end of the first year. Such EWL was maintained thereafter throughout the follow up period and at 24 months follow up the EWL% was 81.30 ± 7.28 %. 55% of our patients were super-superobese, with a mean BMI of 64.85±3.93 kg/m² (range from 60 to 73 kg/m²). The average preoperative weight was 166kg (range from 150-186 kg). In this group of patients sleeve gastrectomy allowed average loss of excess weight by 63.69% at 12 months and 79.58% at 24 months follow up. Weight loss was satisfactory in all patients of this group so, LSG, in the super superobese can be accepted as a definitive treatment. However, there remains a wide range of reported weight loss in the literature. This high variability in reported weight loss could in part be due to the poor standardization of SG with differing inter-institutional agreement on operational technique. In conclusion, the LSG procedure is a safe and effective primary operation for the treatment of morbid obesity.It had excellent weight loss and resolution or improvement of comorbidities without significant side effects; even in the super obese patients. The laparoscopic sleeve gastrectomy (LSG) is quickly becoming a preferred bariatric operation. It is supplanting the lap band and is widely performed now worldwide. It is a restrictive operation that leads to extra body weight loss and a resolution of medical comorbidities similar to the laparoscopic Roux-en-Y gastric bypass.