الفهرس | Only 14 pages are availabe for public view |
Abstract Obesity is a serious global epidemic and poses a significant health threat to humans. The prevalence of obesity is increasing not only in adults, but also among children and adolescents. Obesity is usually defined using the BMI. Generally speaking, a BMI 30 kg/m2 defines a state of obesity while BMI 40 kg/m2 is defined as severe or morbid obesity. At its simplest, obesity is caused by an excess of energy intake over energy expended. Any excess energy intake over and above an individual’s daily requirement will result in that energy being stored. Energy is stored as fat and deposited subcutaneously and viscerally. Etiology of obesity includes genetic and familial, psychological, endocrinal, environmental, hypothalamic factors and drugs. Obesity related comorbidities are variable, widespread and sometimes serious. It includes osteoarthritis, hypertension, non-insulin dependent diabetes mellitus, dyslipidemia, coronary heart diseases, cardiovascular dysfunction, neurological disorders, thromboembolic diseases, respiratory problems, sleep apnea, genital disorders, gastrointestinal complications, endocrinal dysfunction, renal complications, cancers, hernias, skin infections, social and psychological problems and increased risk of mortality at all ages. So, one can easily see the seriousness of the problem in today’s society medically, socially and economically. Non-operative treatment of obesity has commonly been ineffective, and bariatric surgery has been shown to be effective in achieving substantial weight loss and improving obesityrelated co-morbidities in the long-term. Thus, the demand for surgical treatment of morbid obesity has increased dramatically in the past decade. The success of a bariatric procedure is defined by the percentage of EWL and the resolution of obesity-related co-morbidities that have a major effect on the life expectancy of the morbidly obese patient. Although a 50% EWL is generally considered successful, better results can be expected in the long term after RYGB which is considered the gold standard bariatric procedure. Despite the validity of weight loss and comorbidcondition remission after RYGB, 15 to 35 % of patients either fail to lose sufficient weight or regain weight. Experts have attributed regaining weight to various factors, including anatomical, behavioral, and psychological elements. For example, anatomical factors specific to RYGB, such as an enlarged or dilated gastric pouch may play a role in weight regain. In fact, pouch and/or anastomosis enlargement resulting in lack of restriction is the most common reason for failure.Thus, LPR has been proposed to treat IWL or WR after RYGB and appears to be an effective and safe treatment option. Percent EWL and BMI loss from the pre-revision period to post-revision period have demonstrated favorable results with marginal rates of complications. |