الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Obesity is a worldwide problem that reached epidemic level in the past decade, the
recent widespread use of bariatric surgery has been attributed to the high success rate of
weight loss and improvement of comorbidities. This study included experimental phase in
which 18 young male rats were randomized in three 6-rat groups. The rats from the first
group (control) had sham operation; via a laparotomy and performing a 1 cm gastrotomy
and resuturing. In the second group (Sleeve Gastrectomy), via the same laparotomy, had a
sleeve gastrectomy resecting about 70% of the stomach, with closure of the stomach
remnant. In the third group (Mini Gastric Bypass), via the same laparotomy, the stomach
was divided to create a small sleeve shaped pouch to be anastomosed to the jejunum in a
Billroth II fashion at about 5 cm from the duodenum. All animals were weighed on the 7th,
14th and 21st days. The mean preoperative weight of the control group was 130.50 grams (±
3.937), 130.17 grams (± 1.602) in the Sleeve Gastrectomy group, and 130.67 grams (±
3.266) in the Gastric Bypass group. The mean postoperative weight of the control group at
1, 2 and 3 weeks was 139.0 grams (± 3.94), 150.3 grams (± 2.16), and 158.25 grams (±
1.41) respectively. The mean postoperative weight of the Sleeve Gastrectomy group at 1, 2
and 3 weeks was 125.08 grams (± 1.6), 120.9 grams (± 2.11), and 116.4 grams (±2.06)
respectively. The mean postoperative weight of the Gastric Bypass group at 1, 2 and 3
weeks was 125.67 grams (± 3.27), 121.0 grams (± 2.9), and 117.16 grams. The mean
postoperative body weights of both; Sleeve Gastrectomy and Gastric Bypass groups
became significantly less than the mean postoperative body weights of control group at the
1st, 2nd and 3rd weeks postoperatively, with no statistical difference between the mean
postoperative body weights of both; Sleeve Gastrectomy and Gastric Bypass groups.
The clinical phase of the study included a total of forty patients; twenty of them had
Laparoscopic Sleeve Gastrectomy (LSG), and twenty of them had Laparoscopic Mini
Gastric Bypass (MGB) in the Department of Surgery in Medical Research Institute,
Alexandria University from December 2015 till August 2017. All the patients had a oneyear
period of follow up after surgery. The aim of this study was to compare laparoscopic
sleeve gastrectomy to laparoscopic mini gastric bypass regarding their effect on weight
reduction, morbidity (early, and late), impact on obesity associated diseases and effect on
quality of life.
The two groups were well matched as regards their demographic and anthropometric
data. Three patients (15 %) from LSG group, and five patients (25 %) from MGB group
had dyslipidemia. Three patients (15%) from LSG group and four patients (20%) from
MGB group had Diabetes Mellitus. One patient (5%) from LSG group and two patients
(10%) from MGB group had Osteoarthritis of weight bearing joints. Four patients suffered
from hypertension, two (10 %) from LSG group and, two (10 %) from MGB group. One
case from LSG group and two cases from MGB group had Grade “A” GERD (Los
Angeles). There were no statistically significant differences between both groups as
regards preoperative morbidities.
The mean Preoperative weight for the LSG group was 130.80 (± 18.914) kg, while
for the MGB group it was 131.80 (± 15.780) kg. The mean Preoperative BMI for the LSG
group was 47.965 (± 5.076) kg/m2, while for the MGB group it was 48.249 (± 4.500)
kg/m2. Preoperative Quality of Life (QoL) according to Moorehead-Ardelt Quality of Life
Questionnaire II (M-A QoLQII) was varied between very poor and good in both groups,
Summary
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with 75% of LSG group lie in poor and very poor categories, and 70% of MGB group lie
in poor and very poor categories.
LSG was performed for 20 patients, and MGB was performed for other 20 patients.
Patients were allocated randomly into the two groups. All procedures were completed
laparoscopically without conversion. The mean operative time in LSG was 53.25 (± 6.129)
minutes, while in the MGB, it was 74.75 (± 8.188) minutes. Statistically, the operative time
for MGB was significantly longer than LSG.
None of the forty patients suffered from major intraoperative or early (<30 days)
postoperative major surgical complications (e.g. gastric leak, bleeding, other organ injury,
etc.), nor major medical complications (e.g. DVT, pneumonia, lung atelectasis, pulmonary
embolism, etc.). None of the studied patients underwent reoperation. All patients suffered
from nausea, vomiting and epigastric pain with varying degree of severity on the first day
of surgery however they improved on analgesics, prokinetics and proton pump inhibitors.
All the patients were discharged in a good condition and tolerating liquid died. However,
one female patient from LSG group was complaining of persistent vomiting, two weeks
after discharge, and underwent upper GIT endoscopy which identified excess narrowing
(stenosis) at the level of the Incisura Angularis and underwent endoscopic balloon
dilatation for once and patient became well. Upper GI endoscopy after 6 months revealed 3
cases of GERD in LSG group; one of them of Grade “B” (Los Angeles) and two of them of
Grade “A” (Los Angeles), in MGB group, only one case of Grade “A” GERD was
identified. Those patients also had clinical symptoms of GERD, anti-reflux medications
were prescribed for them with good response. The upper GI endoscopy was done at 12
months for symptomatic patients and identified another patient from LSG group with
Grade “A” GERD (Los Angeles), anti-reflux medications were prescribed for her with
good response.
At the end of follow up, BMI became 31.790 (± 1.873) kg/m2 for LSG group and
31.694 (± 1.613) kg/m2 for MGB group. Mean excess weight loss % after one year was
66.99% (± 1.739%) for LSG group and 67.76% (± 1.813%) for MGB group. Weight loss
was associated with improvement of QoL in both groups according to the M-A QoLQII;
the QoL after one year was varied between good and very good in both groups, with 70%
of LSG group lie in very good category, and 75% of MGB group lie in the very good
category. Weight loss was also associated with dramatic improvement of co-morbidities,
with improvement and resolution of co-morbidities in patients of both groups.
The overall result of the operation was assessed using the updated BAROS at
intervals after surgery; at 3 months, 6 months, and one year after surgery. It assessed
%EWL, effect on comorbidities, and QoL using MA QoLQII. Also, it evaluated the
occurrence of complications or reoperations. At the end of the study, 36 patients had
excellent outcomes and four patients had very good outcomes. The outcomes were similar
between both groups over time with no statistical differences between both groups.
Both studied laparoscopic techniques; LSG and MGB were safe and effective, with
similar results as regards significant weight loss and improvement of obesity-associated
medical comorbidities and quality of life, with acceptable morbidity.