الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 105 |  |  |
| | | from | 105 | | |
Abstract
Currently, overweight and obesity represent major health hazards worldwide. Only about 5 % of patients undergoing medical treatment for severe or morbid obesity are able to achieve and maintain significant weight loss. Bariatric surgery has been shown to be the most effective method for achieving this goal and may furthermore improve associated medical conditions.
Gastric bypass (GB) is the most commonly performed bariatric procedure followed by sleeve gastrectomy (SG).
Duodenum is the main place of calcium absorption and in malabsorptive procedures it is bypassed, justifying at least partly the calcium deficiencies. Moreover, absorption of vitamin D from the diet also takes place in duodenum and jejunum, both segments bypassed in malabsorptive procedures. Therefore, levels of parathyroid hormone (PTH) increase after these techniques.
We aimed to compare between the effect of Gastric Bypass and Sleeve Gastrectomy regarding secondary hyperparathyroidism and bone metabolism.
The current study included 100 obese patients divided into two groups;
50 cases underwent sleeve gastrectomy (50%) in group I and 50 cases underwent gastric bypass (50%) in group II.
The patients had been followed up from 6 month to one year following surgery with replacement therapy 1000 mg elemental calcium in form of calcium citrate and 3000 IU vit. D3 daily for persons with normal levels of vit.D prior to surgery or 5000 IU-10000 IU vit.D3 for persons with vit.D deficiency prior to surgery, to detect levels of (parathyroid hormone, serum Ca, 25-hydroxy D3).
Our results showed that:
In laparoscopic sleeve gastrectomy group, parathyroid hormone level showed a significant elevation after 6 months but remains within normal range, and after 1 year it slightly decreased. This decline was statistically insignificant, while in Gastric bypass group, parathyroid hormone showed a significant increase after 6 months and after 1 year.
In accordance with previous data elucidated in the study, statistical analysis revealed significantly higher parathyroid hormone levels in Gastric bypass group, versus laparoscopic sleeve gastrectomy group, after 6 months and after 1 year (p<0.05).
Regarding the presence of high parathyroid hormone level, Gastric bypass group exhibited a significantly higher proportion of patients, after 6 months and after 1 year (p<0.05).
A highly significant positive correlation between baseline calcium level and vitamin D was detected, while a highly significant negative correlation between baseline calcium level and parathyroid hormone (r=-0.449, p=0.001) in laparoscopic sleeve gastrectomy group.
In Gastric bypass group, there was high significant positive correlation between baseline calcium level and vitamin D while there was high significant negative correlation between baseline calcium level and parathyroid hormone (r=-0.427, p=0.002).