الفهرس 
DEFINITION OF OBESITYOnly 14 pages are availabe for public view
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Abstract
obesity is a substantial public-health crisis and its
prevalence is increasing rapidly in numerous developing
nations worldwide. This growing rate represents a pandemic
that needs urgent attention if its potential morbidity, mortality,
and economic tolls are to be avoided.
It increases the risk of a number of diseases including the
two major killers – cardiovascular disease and cancer.
Obesity could be treated with either non-surgical
treatment or surgical treatment. Non-surgical treatment includes
diet therapy, physical activity, behavior medication and
pharmacotherapy. However it showed noncompliance of the
obese patients, non-satisfactory weight loss or regaining the
weight shortly after losing weights.
Bariatric surgery now offers a validated approach that
has a much greater objective success rate of maintenance of an
effective weight loss (up to 50% of excess body weight).
Actually surgical treatment of morbid obesity is gaining
popularity and there is obviously increased interest and
acceptance of Bariatric surgery as a golden way to achieve
stable reduction of body weight in morbidly obese patients
Patients for bariatric operations should be selected with
caution, criteria used in selecting patients for surgery including
body mass index >40 or >35 with co-morbidity. Operation
including restrictive, malabsorptive or combined.The gastric bypass, in its various forms, accounts for a
vast majority of the bariatric surgical procedures performed. It
is well known that it showed higher loss of excess body weight
reach up to 75 % together with stability of the weight loss.
In our thesis we concerned mainly on the possible effect
of such operation mainly the nutritional deficiencies,
concerning calcium, vitamin D together with their effect on
parathyroid hormone levels as calcium is mainly absorbed from
the duodenum and proximal jejunum.
Together with estimation the effect of gastric bypass
surgery on the weight loss we compared the levels of
Parathyroid hormone, vitamin D, alkaline phosphatase and
calcium preoperatively with 3 months, 6 months, 12 months
and 18 months postoperatively and the possible effect of the
length of the Roux limb on such parameters, we also compared
the effect of the seasonal variation on vitamin D levels.
We operated upon 30 cases, 25 cases were done
laparscopicaly and 5 cases were converted to open technique
for different causes. 27 cases had showed accepted weight loss
however 3 cases showed poor weight loss with loss of only
40% excess body weight after 12 months.
We noticed a highly significant difference between
preoperative calcium level and post-operative calcium levels at
3, 6, and 12 and 18 months, as the mean preoperative serum
calcium was higher, although most results were within the
normal range.There was no significant difference between the alkaline
phosphatase and vitamin D levels preoperatively and postoperatively
levels at 3, 6, 12 and 18 months, although the
vitamin D levels had showed seasonal variation with increased
levels mainly during summer months.
Sub analysis of the Vitamin D levels demonstrated that
the patients with LL-RYGB (150 cm) had lesser Vitamin D
levels for all periods of the follow-up compared to their
counterparts with SL-RYGB.
There was a highly significant difference between the
preoperative PTH level and the post-operative PTH levels at 3,
6, and 12 and 18 months, as the mean preoperative serum PTH
was lower.