الفهرس 
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Abstract
The number of obese patients has exponentially grown, and bariatric surgery is considered as an efficient therapy, both for excess weight loss and for the resolution of comorbidities. Despite its several health benefits, the procedure has some potential complications, such as nutritional and metabolic disorders, which vary according to the degree of restriction and malabsorption of nutrients, depending on the performed technique
Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) are the two most common operations performed in the world to treat severe obesity; the most important disadvantage of these surgical techniques is postoperative nutritional deficiencies that require long-term follow-up.
The primary objective of this study was to evaluate the impact of bariatric surgery on weight loss, and comparing the micro-nutrient deficiencies in postoperative morbid obese patients who were undergoing gastric bypass and sleeve gastrectomy with regards to vit B 12, vitamin D, F+ and calcium in the general surgery department at Sohag University Hospital, Egypt.
A total of 50 cases were included in this study, (age and sex matched), all were comorbid obese, the cases were divided into 2 groups; the first group included Twenty-five (25) patients were undergoing sleeve gastrectomy, the second group included Twenty-five (25) patients who were undergoing gastric bypass.
Patients were followed for one year by laboratory testing of CBC, iron study, and vitamin B 12, vitamin D and ionized serum calcium after the 3rd month, 6thmonth, and then after one year postoperative.
The main results of the study revealed that:
The age of the patients ranged from 29 to 56 years, with Mean ± SD. 42.20 ± 7.59 years in the sleeve gastrectomy, and ranged from 25 to 56 years, with Mean ± SD. 43.92 ± 7.12 years in the gastric bypass group.
As regards gender females were more prevalent in both groups; where there were 17(68%) females in sleeve gastrectomy and 16(64%) females in the gastric bypass group.
As regards marital status we found that most patients were married, where the married patients were 16(64%) in sleeve gastrectomy and 19(76%) in the gastric bypass group.
The comparison between the two groups showed that there was no statistically significant difference between the two groups as regards gender, age, and marital status.
There were chronic diseases in the patients of each group preoperatively, but postoperatively these chronic diseases resolved in some patients in both groups, where in the sleeve gastrectomy group hypertension patients declined from 13(52.4%) to 7(28%), and diabetes mellitus patients declined from 9(36%) to 5(20%), and dyslipidemia patients declined from 25(100%) to 10(40%), while in gastric bypass group hypertension patients declined from 12(48%) to 6(24%), and diabetes mellitus patients declined from 8(32%) to 4(16%), and dyslipidemia patients declined from 25(100%) to 10(40%). The comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative and postoperative chronic diseases, and the resolve of chronic diseases was almost equal in both groups.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in weight at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative weight and 3- and 6-months postoperative weight while there was statistically significant decrease in gastric bypass group as regards weight 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant increase in weight loss at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was statistically significant increase in weight loss at 3, 6, and 12 months postoperatively in gastric bypass group more than the sleeve gastrectomy group.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in BMI at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative BMI and 3- and 6-months postoperative BMI while there was statistically significant decrease in gastric bypass group rather than sleeve gastrectomy group as regards BMI 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in Hb A1c at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was statistically significant decrease in Hb A1c in the gastric bypass group rather than the sleeve gastrectomy group at 6- and 12-months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant increase in vit D at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative vit D while there was statistically significant increase in sleeve gastrectomy group than gastric bypass group as regards 3- and 6-months postoperative vit D, while this difference became insignificant at 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant increase in HDL at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative HDL and 3- and 6-months postoperative HDL while there was statistically significant increase in HDL 12 months postoperatively in sleeve gastrectomy group than gastric bypass.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in triglycerides at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative triglycerides and 3- and 6-months postoperative triglycerides while there was statistically significant decrease in gastric bypass group as regards triglycerides 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in LDL at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative LDL and 3- and 6-months postoperative LDL while there was statistically significant decrease in gastric bypass group than sleeve gastrectomy as regards LDL 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in Hb at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative Hb, however there was statistically significant increase in sleeve gastrectomy group than gastric bypass group as regards Hb 3-, 6-, and 12-months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in iron at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that the decrease was statistically significant higher in the gastric bypass group than the sleeve gastrectomy group 3-, 6- and 12-months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant increase in ferritin at 3, 6, and 12 months postoperatively in the sleeve gastrectomy group than preoperatively, while there was statistically significant decrease in ferritin at 3, 6, and 12 months postoperatively in the gastric bypass group than preoperatively, the comparison between the two groups showed that there was statistically significant increase in sleeve gastrectomy group than gastric bypass group as regards ferritin 3-, 6-, and 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was no statistically significant difference in Calcium at 3, 6, and 12 months postoperatively in the sleeve gastrectomy group than preoperatively, while there was statistically significant decrease in Calcium at 3, 6, and 12 months postoperatively in the gastric bypass group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative Calcium and 3- months postoperative Calcium while there was statistically significant increase in sleeve gastrectomy group as regards Calcium 6-, 12 months postoperatively.
Comparison between patients results after surgery with before surgery in each group showed that, there was statistically significant decrease in vit B12 at 3, 6, and 12 months postoperatively in each group than preoperatively, while the comparison between the two groups showed that there was no statistically significant difference between the two groups as regards preoperative vit B12 and 3- and 6-months postoperative vit B12 while there was statistically significant higher in sleeve gastrectomy group than gastric bypass group as regards vit B12 at 12 months postoperatively.
Based on these results, recommendation for further studies on larger patients and longer period of follow up to emphasize this conclusion
CONCLUSION
In conclusion, both LSG, and LGB surgeries are effective in lowering body weight and resolving chronic diseases as hypertension, type 2 diabetes, and dyslipidemia. However, LGB was more effective in lowering weight, blood glucose level, lipid profile than LSG, but micro-nutritional deficiencies were more prevalent in LGB than LSG.
RECOMMENDATIONS
Supplementation are recommended for postoperative metabolic deficiencies.
LGB surgeries are more recommended in resolving chronic diseases as hypertension, type 2 diabetes, and dyslipidemia rather than LSG.
Further studies are recommended.