الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Obesity is one of the most pervasive, chronic diseases in need of new strategies for medical treatment and prevention. Obesity is defined as excess adipose tissue. There are several different methods for determining excess adipose (fat) tissue; the most common being the Body Mass Index (BMI).
A fat cell and adipose tissue are an endocrine organ. As such, adipose tissue secretes a number of products, including metabolites, cytokines, lipids, and coagulation factors among others. Significantly, excess adiposity or obesity causes increased levels of circulating fatty acids and inflammation. This can lead to insulin resistance, which in turn can lead to type 2 diabetes.
Obesity puts individuals at risk for more than 30 chronic health conditions. They include: type 2 diabetes, high cholesterol, hypertension, gallstones, heart disease, fatty liver disease, sleep apnea, GERD, stress incontinence, heart failure, degenerative joint disease, birth defects, miscarriages, asthma another respiratory conditions, and numerous cancers.
Surgical treatment of obesity is also known as bariatric surgery or weight loss surgery and they are the most effective treatment for obesity resulting in durable and sustainable loss of weight and accompanying health improvements.
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery), the most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy.
(LSG) has been became a primary surgical treatment for obesity and associated diseases, this procedure works by several mechanisms. The new stomach pouch holds a smaller volume than the normal stomach and helps to significantly restrict the amount of food (and thus calories) that can be consumed. However, the greater impact seems to be the changes of gut hormones that affect a number of factors as blood sugar control, hunger, and satiety.
The technique of performing the LSG is not consistent among bariatric surgeons. The steps in common are evaluation for the presence of a hiatal hernia and repair ; division of the greater omentum and the short gastric vessels for mobilization of the greater curvature of the stomach ; using bougies as calibration before stapling ; a stapled vertical gastrectomy, usually starting 2 to 6 cm proximal to the pylorus; and lastly, removal of the specimen . The objectives in this study is to compare the outcomes of two different starting distances, 2 and 6 cm from pylorus in LSG on degree of weight loss, reflux symptoms and other complications and time of emptying the stomach after meals. This comparative study had been conducted in Menofia University hospital. The study comprises 40 patients with different degrees of obesity indicated for LSG.
Patients were randomized into two equal groups: group (1) included 20 patients subjected to LSG with 2 cm distance from pylorus and group (2) included 20 patients subjected to LSG with 6 cm distance from pylorus.
Age and sex of the patients were recorded. BMI of the patients was calculated as weight (kg), divided by height (m) squared.
Patients were subjected to history taking, clinical examination, laboratory and radiological investigations and upper endoscopy.