الفهرس 
Anatomy of the StomachOnly 14 pages are availabe for public view
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Abstract
Obesity has become major health problem in both developed and developing nations, because of its high prevalence and causal relationship with serious medical and psychological complications, such as diabetes, hypertension, and hyperlipidemia. Diabetes, in particular, is strongly associated with obesity: the prevalence of diabetes was 3% among individuals of healthy weight, 6% among over weight individuals, 11% among obese individuals, and 19% among the extremely obese.
Little is known about the aetiology of obesity. There are propably spectrum of different kinds of disorders as genetic, environmental or both which increase intake, decrease expendature of an obese individual.
Obesity is typically evaluated in absolute terms by measuring body mass index (BMI) but also in terms of its distribution through waist circumference or waist-hip circumference ratio measurements.According to BMI, obesity is defined as 30 Kg/m2 over desirable weight and morbid obesity is defined as BMI over 40 Kg/m2. More recently, another category, super obesity has been defined as BMI greater than 50Kg\m2 over desirable weight.
The risk of metabolic complications and comorbid factors is related to both BMI and waist circumference specifically the risks of hypertension (3.0 times higher) and risks of diabetes mellitus (2.9 Times higher) and risk of atherosclerosis (1.5 times higher).
Effective weight loss therapy can reverse many of the adverse effects of severe obesity. Available therapies include lifestyle changes (diet and exercise), very-low-calorie diets, pharmacologic therapy, and surgery. Of these, bariatric surgery is documented as the most consistently effective therapeutic intervention for the severely obese.
Surgery is usually successful in inducing substantial weight loss in the majority of obese patients with improvement or reversal of obesity-related comorbidities and is achieved primarily by an inevitable reduction in energy intake.
Bariatric surgical procedures can be categorized as malabsorptive, restrictive, or combined, based on their effects on the digestive system. Biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS) are malabsorptive, laparoscopic adjustable gastric banding (LAGB) is restrictive, and Roux-en-Y gastric bypass (RYGB) combines both malabsorptive and restrictive features.
With open procedures of bariatric surgery patients are more likely to experience a postoperative complication than those undergoing laparoscopic surgery. Patients were significantly more likely to experience pulmonary complications, cardiovascular complications, sepsis, and anastomotic leak. In addition laparoscopic procedures cause reduction in abdominal wall complications and a shorter hospital stay. The midterm weight loss is similar with both techniques.
One inconvenience is that laparoscopic procedures have a more complex learning curve which may be associated with an increase in postoperative complications. Experience of the surgeon and surgical team and providing preoperative and postoperative support is critical to the success of bariatric surgery.
The most commonly performed procedures for morbid obesity at this time are RYGB, LAGB, and SG. Each procedure has advantages and disadvantages.The appropriate choice of operation begins with a full assessment of the patient’s reasons for choosing as well as expectations of weight loss surgery. Information can then be gathered from the history and physical examination, laboratory data, imaging and endoscopic studies, and prior operative notes. Arbitrarily, choice of procedure can be determined by weight, presence of comorbid illness, age, and relevant previous surgery.
concerning the current prospects of bariatric surgery;
There is good evidence that gastric surgery leads to loss of large amounts of weight in patients who are very obese, and in whom all other remedies have failed. There is reasonable quality evidence that GB surgery leads to a greater loss of weight in morbidly obese patients than from VBG or horizontal GP. Patients lost approximately 25% more excess weight by 1 year after GB than those patients who had a VBG. By 5 years the difference had increased to 33%. Compared with horizontal GP, GB led to a similar difference in the loss of excess weight. Side effects of the procedures, including dumping syndrome and heartburn, were more evident following GB than the different forms of GP. Postoperative deaths were reported following GB and horizontal GP. Revisions, re-operations and/or conversions were more common following GP than following GB. Additional procedures following weight loss, such as trimming procedures, were more common following GB than GP. JB led to slightly greater loss of excess weight than GB; with morbidly obese patients losing at least 9% more excess weight at 1, 2 and 3 years. Complications affected more of the JB patients than GB patients, with 80% of JB patients suffering a worsening of liver disease compared with improvements in liver disease among 83% of GB patients. Some 63% of GB and 48% of JB patients experienced complications of surgery, such as wound infection and urinary tract infection. Reoperation was necessary in 16% of GB and 32% of JB patients. Vomiting is more common with VBG, which probably reflects the greater success of that procedure in reducing stomach capacity. There was greater weight loss over 5 years with adjustable banding than with VBG. There were also fewer side-effects and greater patient satisfaction with adjustable banding.