الفهرس 
Introduction and Aim of WorkOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Obesity is considered a major health and socio economic
problem. Over weight, obesity and morbid obesity are terms often
used to describe individuals with and increased body fat. The
most common definition of morbid obesity is a body mass index
(BMI) of 40 Kg /m2 or more. More than 250 millions individuals
are obese. The aetiology of this condition is multi factors
including; familial and genetic predisposition, drug induced
obesity, endocrinal causes, childhood over nutrition, intake of
food in large quantities and many times in the day, psychological
factors, environmental factors, special habits like alcohol
consumption and smoking and personal factors like; age, gender,
ethinity and parity.
Clear understanding of the pathophysiology of morbid
obesity is essential for management and prevention of this
disaster. There are several factors concerning the occurrence of
obesity, the first one in this mechanism is the genetic control also
central nervous system control, afferent signals, pattern of
feeding, socioeconomic factors, exercise and pattern of
distribution of excess adipose tissue, leptin also, have a role in the
mechanism of this disease. Leptin is the best known of the
afferent fat signals and the best candidate for primary signal
communication of body fat information to the central controller.
There are many disastrous diseases associated with morbid
obesity including; cardiovascular diseases, diabetes mellitus,
respiratory problems, digestive diseases, arthritis, chronic
abdominal compartmental syndrome, hernia, infectious
problems,endocrinal abnormalities, psychological problems,
complications associated with pregnancy, cancer, neurological
complications and other medical problems compounded by
obesity.
The goal of weight-loss therapy is to improve health by
modifying obesity-related diseases and the risk for future obesityrelated
medical complications
Treatment of morbid obesity may be conservative as
medical treatment (behavior modification, diet regimen, exercise
and drugs) and active physical interventions (as jaw wiring,
gastric balloon, acupuncture and waist cord) or it may be surgical
as which may be open as gastric by- pass, intestinal bypass and
gastroplasty which divided in to Vertical banded gastroplasty,
horizontal gasroplasty, gastric banding and gastric wrap or
laparoscopic surgery as laparoscopic vertical banded gastroplasty,
laparoscopic adjustable gastric banding, laparoscopic gastric
bypass, laparoscopic malabsorpative procedure and laparoscopic
bariatric pacing.
Surgical treatment seems to be more effective in the
management of morbid obesity with acceptable rate of
complications. The surgical modalities used in the bariatric
surgery initially used in treating other conditions, and these
modalities were found to cause weight loss post- operatively as a
side effect.
It is obvious from the number of procedures practiced that
the ideal operation for morbid obesity has not been developed.
This is because these producers are accompanied by significant
morbidly and mortality that varies between 1 and 5 %. The most
common and accepted procedure nowadays is gastric banding.
This is because of the preservation of the normal anatomy of the
upper gastrointestinal tract and the possibility of reverse of this
procedure if the postoperative complications cannot be
overcomed. The idea of this technique is the usage of a dacron
tube or silicon bands to compartmentalize the stomach into small
proximal and large distal segments. It is a pure restrictive
technique with the ability to reverse it in any time with un
avoided complications.
Also now Roux -en-Y gastric bypass (RYGBP) is currently
one of the most frequently performed procedures for the surgical
treatment of morbid obesity especially for severly morbid obesity,
with high success of this procedure in weight loss.
Laparoscopic bariatric surgery take place in the last few
years strongly, due to the greatly diminished post-operative
complications. It is indicated in severe obesity especially if it is
associated with the severe comorbidities.
Single port laparoscopy has been proposed to as a less
invasive alternative that might deliver these benefits. A single
central point of access limits the instruments to in-line, parallel
movements.
Patients undergoing bariatric surgery are considered to be
at high risk for surgical complications regardless of whether their
surgery is open or laparoscopic.
These postoperative complications are enteric leaks,
intestinal obstruction from internal herniation, intra-abdominal
bleeding, gastrointestinal bleeding, Strictureformation, deep vein
thrombosis (DVT), marginal ulcers, gall bladder stones,incisional
hernia, rhabdomyolysis and compartment syndrome.
Nutritional deficiency after bariatric surgery is common.
All of the procedures induce malnutrition by a reduction in
volume aswell as a change in the type of food. Since most
vitamins and minerals are absorbed in the upper small intestines,
namely the duodenum and jejunum, it should not be surprising
that some patients may develop malabsorptive syndromes.
These deficiencies are protein deficiency, carbohydrate
deficiency, Fatty Acid Deficiency, vitamin B12 deficiency, folate
deficiency, vitamin B1 deficiency, vitamin A deficiency, Iron
deficiency, calcium deficiency and Zinc deficiency.