الفهرس 
Definition of the ObesityOnly 14 pages are availabe for public view
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Abstract
Obesity is a worldwide medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and increased health problems.
Obesity is a multifactorial abnormality that has a genetic basis but requires environmental influences to manifest as lack of physical activity and dietary factors.
The non-surgical approaches through reduced caloric intake and increased physical activity, combined with pharmacotherapy are effective approaches for weight loss, however these measures with morbid obesity fails to produce long term weight loss, since several bariatric surgical techniques have been developed.
Bariatric surgery is the most effective treatment for long-term reduction of body weight. Bariatric surgery should at least be considered for all patients with a BMI
Of more than 40 kg/m2 and for those patients with a BMI of more than 35 kg/m2 with important obesity related co-morbid conditions.
There are two major categories of weight-loss surgery: gastric restriction such as vertical banded gastroplasty (VBG), gastric banding, sleeve gastrectomy and intestinal malabsorption which include Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD).
The Sleeve Gastrectomy (SG) is a restrictive procedure that creates a 100- to 150-mL stomach by performing a partial gastrectomy of the greater curvature side of the stomach. The last 6 to 8 cm of antrum remains intact, and thus, the pylorus is preserved to help prevent gastric emptying problems.
At times, an intraoperative decision is made to perform an SG instead of a more technically challenging malabsorptive procedure, if the latter is felt to be too dangerous. This choice is usually prompted by adhesions or a body habitus that compromises adequate visualization. After significant weight loss has occurred, the SG can be revised to a BPD-DS or a RYGB to treat the remaining obesity.
The vertical banded gastroplasty (VBG) is a restrictive procedure that consists of a vertically oriented proximal small pouch (less than 30 mL) that drains through a narrow (10–12 mm) gastric channel. The outlet channel is reinforced with a band of polypropylene (Marlex) mesh.
With VBG procedure the stapling of the stomach carries the risk of staple-line disruption that can result in leakage and long-term weight gain. For these reasons, some surgeons divide the staple-line wall of the pouch from the rest of the stomach to reduce the risk of long-term staple-line disruption.
With butterfly gastroplasty a micro funnel shaped pouch was constructed limited to cardia using two endo-cutter cartridges, and the outlet of the pouch was banded with prolene mesh. This markedly decrease the incidence of complication rates after original VBG specially weight regain due to pouch dilatation.
With Construction of micro pouch in butterfly gastroplasty, the first endo-cutter cartridge applied from angle of his downward with complete exclusion of gastric fundus. At the level of the first branch of Lt. gastric artery the retro-gastric space is dissected and the second endo-cutter cartridge is applied with accurate adjustment of the pouch outlet (1.2 cm).
The most revolutionary change in bariatric surgery has been the advent of laparoscopic approach, the minimal invasive laparoscopic technique has been performed to shorten the operative time and to reduce the complications of the open surgery.
Although laparoscopic approach has decided advantages over the open technique there is also an accompanying learning curve that must be surmounted before these benefits are accrued.
This research will determine and evaluate the impact of both restrictive bariatric surgeries; the butterfly gastroplasty and sleeve gastrectomy on weight loss and early postoperative complications.
This study included 60 patients who were divided into two groups every group had 30 patients. The group (A) patients had undergone laparoscopic butterfly gastroplasty. The group (B) patients had laparoscopic sleeve gastrectomy, and the both procedure were taken place in Ain Shams university hospital and Ahmed Maher Teaching hospital.
The benefits of this study were to compare the effect of both restrictive procedures; butterfly gastroplasty and sleeve gastrectomy on morbid obese patients, aiming to decrease incidence of early postoperative complications with obtaining the satisfactory effect in weight loss.
The final results of this study revealed that the both restrictive procedure; the butterfly gastroplasty and the sleeve gastrectomy had the same percentage of postoperative complications by 6.7%, however the butterfly gastroplasty achieved more excess weight loss percentage in comparison to sleeve gastrectomy by 64% to 56% respectively after follow up for12 month.
In conclusion, butterfly gastroplasty can be an appropriate restrictive procedure with good short-term results and low morbidity rates in comparison to sleeve gastrectomy.