الفهرس 
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Abstract
SUMMARY UMMARYUMMARYUMMARYUMMARY
Obesity is the most common form of malnutrition in developed countries. Prevalence of obesity is rising to an epidemic proportion around the world.
Obesity increases the risk of medical illness and premature death and thus imposes an enormous economic burden on the health care system.
Many morbidities are underlying causes for the earlier mortality associated with obesity including coronary artery disease, hypertension, impaired cardiac function, adult onset diabetes mellitus, venous stasis and hypercoagulability leading to an increased risk of pulmonary embolism.
The most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in kilograms divided by the square of his or her height in meters, a normal BMI ranges from 18.5-24.5 kg/m2, overweight equals BMI between 25-29.5 kg/m2, obesity equals BMI 30 kg/m2 or higher.
Treatment of morbid obesity should begin with simple lifestyle changes, including moderation of diet and initiation of regular exercise such as walking and pharmacological management.
Summary and Conclusion
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However, the only effective treatment for morbid obesity is bariatric surgery. Bariatric surgical techniques are divided into two groups: malabsorptive and restrictive procedures.
The SG, also called greater-curvature, vertical, parietal as well as longitudinal gastrectomy is a new tool in the armamentarium of all bariatric surgeons.The use of SG extended worldwide due to its major potential benefits, including its technical simplicity and significant weight-loss outcomes with low rate of complications and mortality.
The concept that the SG is a purely restrictive procedure is gradually changing. The significant reduction of large parts of the ghrelin-producing stomach mass and changes in gastric emptying may account for its superiority to other restrictive procedures in terms of weight loss and sustained decrease of hunger.
Surgeons should understand the complications associated with SG and an approach for dealing with them. Early postoperative complications following SG that need to be identified urgently include bleeding, staple line leak and development of an abscess. Delayed complications include strictures, nutritional deficiencies and gastroesophageal reflux disease.
The American Society for Metabolic and Bariatric Surgery (ASMBS) Clinical Issues Committee statement quotes an overall complication rate for SG of 0–24 % and a mortality rate of 0.39 %
Of the dreaded complications after SG is a gastric leak, most commonly occurring at the upper staple line near the gastroesophageal junction. This complication may lead to abdominal sepsis, which might progress either to chronic gastric fistula or to multi-organ failure and patient demise.
Many surgeons have used different methods for staple line reinforcement in laparoscopic sleeve gastrectomy operations. Although the importance of staple line reinforcement is described in literature, it is still controversial.
Many possibilities of leak treatment include oversewing, drainage (CT guided or open, with NG feeding or with TPN), and endoscopic clippings. Persisting fistulas can be treated with fibrin glue, stents, Roux loop, or with total Gastrectomy.
Bleeding can occur from gastric blood vessels during dissection of the greater curve of the stomach. Most bleeding problems associated with SG occur from the staple line after transection of the stomach.
SG may induce or exacerbate gastro-esophageal reflux disease GERD in patients, requiring proton pump inhibitor (PPI) therapy. Coexisting hiatus hernia should be assessed and repaired during SG.
One of the infrequent complications of SG is the stenosis of the remnant stomach. Possible causes are ischemia of the pouch, retraction due to scarring, fistula, and inclusion of the
esophago-gastric junction in the stapling line. Treatment options include endoscopic covered stent placement, laparoscopic seromyotomy, Roux -en -Y gastric bypass, resecting the remaining stomach and building the anastomosis.
SG may be effective treatment for morbid obesity up to 2 years after surgery; however it has been evident that a sub-group of patients regain weight. Dilatation may be the first cause of failure.
Nutritional deficiencies after SG are rarely encountered. Regular determination of laboratory parameters should be performed 6 months after the operation and semiannually thereafter; if the patient‗s weight stabilizes, laboratory parameters should be determined once a year.
The morbidly obese are at higher risk for development of deep venous thrombosis, and they have little cardiopulmonary reserve if a pulmonary embolus occurs. Pulmonary embolism is an established cause of mortality after bariatric surgery.
Perioperative subcutaneous heparin administration, early ambulation, graduated compression stockings (GCS), intermittent compression devices (ICDs) in combination with enoxaparin (LMWH) achieves a low incidence of venous thrombosis complications following SG.
Then as more surgeons adopt the SG as a primary procedure for weight loss, more cases of surgical management of failure will be reported, helping us understand the reasons and
options for revisional or conversional surgery in this patient population.
When the issues of nutritional management have been adequately addressed and technical problems of inadequate fundal resection have been ruled out, the decision to revise to other options can be assessed. Revision options include Re-sleeve, RYGB, BPD-DS or the new technique; SADI-s.