الفهرس 
Treatment of obesityOnly 14 pages are availabe for public view
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Abstract
Obesity has become a worldwide public health problem affecting millions of people. This is a chronic, stigmatized, and costly disease, rarely curable and is increasing in prevalence to a point today where we define obesity as an epidemic disease that not only in developed but also on developing countries. The pathogenesis of obesity is largely unknown, especially about energy regulatory mechanism that involved wide area of neuroendocrinology that is very interesting but very complex. Obesity occurs through a longstanding imbalance between energy intake and energy expenditure, influenced by a complex biologic system that regulates appetite and adiposity. Obesity influences the pathogenesis of hypertension, type 2 diabetes, dyslipidemia, kidney, heart, and cerebrovascular disease. Until now, the available treatments, including drugs, are palliative and are effective only while the treatment is being actively used; and besides so many side effects reported.
There is growing consensus that bariatric surgery is the predominant treatment option for the majority of individuals who have clinically severe obesity and are at the highest risk for obesity-related mortality and comorbidity. The number of bariatric surgery procedures has increased significantly over the past few decades.
Sleeve gastrectomy has increasingly gained acceptance among bariatric surgeons over the past five years, and has become a feasible option in the management of morbid obesity. from the current evidence, it seems that the procedure has proven to be an effective weight loss alternative that can be performed safely as a first stage or primary procedure. SG is gaining popularity whether as a primary, staged or revisional operation for its proven safety and
Summary 105
short-term efficacy. Although the SG encompasses a long staple line, the risk of gastric leak is as low as the RYGB.
Different techniques are implemented to reinforce the staple line including buttressing and over-sewing; however, the latter seems to be associated with higher incidence of sleeve stricture. Overall, the complication rate of SG is equivalent to RYGB, BPD-DS, and AGB with less nutritional complications, dumping syndrome, internal hernia, marginal ulcers, foreign body, and port access problems that plague more traditional bariatric operations. Although SG was initially intended for high-risk, high-BMI patients, a second-stage surgical procedure is not warranted if adequate weight loss and comorbidity resolution is achieved exclusively by SG. LSG appears to be subjected to weight regain after more than 3 years and the sleeved stomach might dilate over time. This neofundus issue could be important as it causes both weight regain and GERD.
To conclude, we believe that LSG is a safe, effective, and by the patients well accepted bariatric procedure, but it appears to be associated with weight regain and quite often with reflux symptoms in long-term follow-up. Weight regain could probably be at least partly avoided by tighter follow-up. Weight regain, but not GERD after LSG can be managed successfully by completion of a DS procedure at a later stage.