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Abstract obesity is a substantial public-health crisis and its prevalence is increasing rapidly in numerous developing nations worldwide. This growing rate represents a pandemic that needs urgent attention if its potential morbidity, mortality, and economic tolls are to be avoided. It increases the risk of a number of diseases including the two major killers – cardiovascular disease and cancer. Obesity could be treated with either non-surgical treatment or surgical treatment. Non-surgical treatment includes diet therapy, physical activity, behavior medication and pharmacotherapy. However it showed noncompliance of the obese patients, non-satisfactory weight loss or regaining the weight shortly after losing weights. Bariatric surgery now offers a validated approach that has a much greater objective success rate of maintenance of an effective weight loss (up to 50% of excess body weight). Actually surgical treatment of morbid obesity is gaining popularity and there is obviously increased interest and acceptance of Bariatric surgery as a golden way to achieve stable reduction of body weight in morbidly obese patients Patients for bariatric operations should be selected with caution, criteria used in selecting patients for surgery including body mass index >40 or >35 with co-morbidity. Operation including restrictive, malabsorptive or combined.The gastric bypass, in its various forms, accounts for a vast majority of the bariatric surgical procedures performed. It is well known that it showed higher loss of excess body weight reach up to 75 % together with stability of the weight loss. In our thesis we concerned mainly on the possible effect of such operation mainly the nutritional deficiencies, concerning calcium, vitamin D together with their effect on parathyroid hormone levels as calcium is mainly absorbed from the duodenum and proximal jejunum. Together with estimation the effect of gastric bypass surgery on the weight loss we compared the levels of Parathyroid hormone, vitamin D, alkaline phosphatase and calcium preoperatively with 3 months, 6 months, 12 months and 18 months postoperatively and the possible effect of the length of the Roux limb on such parameters, we also compared the effect of the seasonal variation on vitamin D levels. We operated upon 30 cases, 25 cases were done laparscopicaly and 5 cases were converted to open technique for different causes. 27 cases had showed accepted weight loss however 3 cases showed poor weight loss with loss of only 40% excess body weight after 12 months. We noticed a highly significant difference between preoperative calcium level and post-operative calcium levels at 3, 6, and 12 and 18 months, as the mean preoperative serum calcium was higher, although most results were within the normal range.There was no significant difference between the alkaline phosphatase and vitamin D levels preoperatively and postoperatively levels at 3, 6, 12 and 18 months, although the vitamin D levels had showed seasonal variation with increased levels mainly during summer months. Sub analysis of the Vitamin D levels demonstrated that the patients with LL-RYGB (150 cm) had lesser Vitamin D levels for all periods of the follow-up compared to their counterparts with SL-RYGB. There was a highly significant difference between the preoperative PTH level and the post-operative PTH levels at 3, 6, and 12 and 18 months, as the mean preoperative serum PTH was lower. |