الفهرس 
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Abstract
The rising prevalence of morbid obesity and the increased incidence of super-obese patients seeking surgical treatments have led to the search for surgical techniques that provide adequate EWL and curing from the co-morbidities with the least possible morbidity. Obesity is the most frequent chronic metabolic disease worldwide with its prevalence reaching pandemic proportions. Morbid (extreme) obesity has been defined as body mass index (BMI) >40 kg/m2 [3]. Obesity is an established risk factor for cardiovascular disease, insulin resistance, hyperinsulinemia, type 2 diabetes, and dyslipidemia. Patients with morbid obesity are prone to such complications. Morbidity and the risk of premature death are related to the amount and distribution of excess body fat. Numerous studies have demonstrated a direct correlation between increasing BMI and elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) and an inverse relationship with high-density lipoprotein cholesterol (HDL-C). This association between BMI and lipoprotein levels, particularly LDL-C, has been suggested to be a contributing factor in the higher rates of cardiovascular events associated with obesity. The aim of this study is to evaluate the effect of Sleeve Gastrectomy on lipid profile at 3, 6, and 12 months after the surgery. This study has been conducted in Assiut University Hospitals and Kasr- ALaini new teaching hospital in the period between September 2016 and May 2016. The first 20 patients with morbid obesity and dyslipidemia attending the outpatient clinic matching the inclusion criteria and consenting to participate in the study were included. They underwent LSG. The study included patients with BMI > 40 or BMI > 35 with co-morbidities, age between 16-60, previous failed attempts of medical management approaches such as lifestyle modification through proper nutrition and increased exercise, behavioral modification and medication. Patients with endocrinal disorders leading to obesity, psychological disorders, addiction or had previous bariatric surgeries were excluded. All patients were subjected to full clinical and routine laboratory evaluation. Clinical evaluation aimed at assessment of degree of obesity, preoperative evaluation and detection of different complications of morbid obesity like hypertension, diabetes and dyslipidemia. LSG was performed using five ports including one port for liver retractor and a 36 French bougie, starting the resection 3-6 cm proximal to the pylorus. All patients were instructed to take oral fluids for 2 weeks followed by semisolid and pureed diet for another 2 weeks then start normal feeding in the form of small frequent well chewed meals. Follow up by assessment of weight, improvement in co-morbidities and changes in lipid profile at 3, 6 and 12 months postoperatively were done. The mean duration of surgery was 60 mins. No major intra-operative complications occurred. One patient had post operative bleeding. Seven patients had minor complications in the form of wound infection that were all treated conservatively. In our study there were no cases with leakage or mortality. The mean preoperative total cholesterol was 204+-39.0mg/dl. There was a reduction in the levels of this lipoprotein in all postoperative evaluation, the mean total cholesterol level found was 190.2±39.9 mg/dl. We conclude that LSG produces an improvement in lipid profile, with a significant increase in HDL and a decrease in LDL , triglycerides , and non-HDL-C. A long-term follow-up is needed to further define the role of LSG in the management of dyslipidemia. Therefore, we conclude that SG leads to a proper control of the lipid profile, and should be considered when planning the treatment of a patient with difficulty to control dyslipidemia. An observational retrospective researches will needed for assess short-term outcomes such as : record substance abuse like smoking or alcoholism which might affect the lipid metabolism and study , an important association between lipid profile and weight loss regardless of malabsorption . Other researches about long-term follow-up might be necessary to define the association between TC and weight loss after LSG and also a prospective comparison with LGBP in order to evaluate the malabsorptive component. Future research is needed to investigate changes in QOL in different domains in the short- and long-term following LSG surgery. The effect of Physical activity study is recognized as an effective non-pharmacological intervention to reduce body fat mass and hypercholesterolemia.