الفهرس 
PATHOPHYSIOLOGY OF SUPER MORBID OBESITYOnly 14 pages are availabe for public view
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Abstract
B
ody Mass Index (BMI) is considered to represent the most practical measure of a recipient’s body fat. It is calculated by dividing the weight in kilograms by the height in meters squared (kg/m2).
Super obesity is associated with increased morbidity and mortality. Morbidity appears with hypertension, lipid disturbances, non-alcoholic steatohepatitis, obstructive sleep apnea and polycystic ovary syndrome, insulin resistance, and diabetes these comorbidities are responsible for more than 2.5 millions deaths per year worldwide.
Surgical treatment for these patients is an important consideration, because no other weight eduction therapy appears to be effective. In addition to our concerns about the safety of operating on this patient population, controversy exists regarding the best method to achieve optimal weight loss.
The super obese patients are generally thought of as more difficult to treat and to require longer hospital stays. The results of surgery in terms of weight loss have been classified as less satisfactory, because many of these patients, even after significant weight loss, remain morbidly obese
Bariatric surgical procedures are categorized into 2 main types; restrictive and malabsorptive. Some operations combine both restriction and malabsorption.
RYGBP is modified by lengthening the portion of the intestine within which absorption is limited (because of a lack of interaction of food with bile and pancreatic enzymes) appears as an appealing opportunity to improve weight loss profile.
The long Roux-limb might be efficacious at improving postoperative weight loss in super obese patients. Moreover, it does not seem that an increased limb length endanger the vitamin and mineral absorption more than a standard RYGBP.
Intragastric balloon or single port sleeve procedure is offered to high risk morbidly obese patients, including those with a high BMI, central obesity, multiple abdominal surgeries, or those who also have significant comorbid conditions
The philosophy of performing two steps procedure shows the best feedback in management of super obese patients. rests on the potential benefits for both patients and bariatric surgeons. from the patient’s viewpoint, First step as vertical banded gastroplasty, Sleeve Gastrectomy and intragastric ballon (first bariatric procedure) offers the possibility of weight loss and overall improvements in, or even resolution of, obesity-related co-morbidities, and some patients might not require the second step as Roux-en-Y gastric bypass and biliopancreatic diversion (second bariatric procedure). That said, the second step is usually well tolerated with a smoother recovery. The interval between the first and second procedures allows time for psychological and physical improvements in the patient’s health before additional surgery.