الفهرس 
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Abstract
SUMMARY
O
besity is one of the major problems in the world and is associated with several comorbidities and disabling diseases e.g. cardiovascular disease, metabolic syndrome, type 2 diabetes mellitus (T2DM), infertility, certain tumor types, and increased obesity associated mortality.
Management consists of Conservative measures such as diet modifications.
Physical exercise and pharmacological therapy. There is considerable evidence in the literature on the long-term positive impact of bariatric surgery as a primary therapy for the treatment of obesity and its comorbidities. Significant debate remains as to which patients are optimal candidates for which procedure.
Bariatric surgery is the most effective treatment for morbid obesity and, depending on the type of operation, is also very effective in the resolution of diabetes.
Traditionally, the primary mechanisms through which bariatric surgery achieves its outcomes are believed to be the mechanical restriction of food intake, reduction in the absorption of ingested foods, or a combination of both.
Laparoscopic sleeve gastrectomy (SG) is a restrictive approach used commonly in bariatric practice, Sleeve gastrectomy was first described in 1999 as part of the biliopancreatic diversion duodenal switch procedure. Subsequently, laparoscopic sleeve gastrectomy (LSG) has been performed as a standalone procedure.
Although these procedures have proven to be good therapeutic options for some patients, it is not without significant complications, such as gastric leaks which pose a particularly difficult challenge when they occur near the angle of His, potentially generating severe clinical conditions that require reoperation, and may even cause death.
The prevalence of gastroesophageal reflux disease )GERD( is markedly increased in obese patients compared with the incidence in normal individuals, with a percentage of up to 70% of patients undergoing bariatric surgery.
SG may associated with an increase in GERD prevalence. The measured increase in GERD prevalence ranged from 2.1% to 34.9% in the analyzed literature. There was marked heterogeneity between the studies in regard to a number of factors including preoperative BMI, method of evaluating GERD, exclusion criteria, length of follow-up and operative technique.
LSG was proven to be an effective weight loss surgery with significant weight loss and decrease of abdominal visceral fat. The accompanied decrease of intra-abdominal pressure may contribute to the improvement of GERD symptoms and reduce the medication of GERD after LSG.
Multiple mechanisms involved in de novo GERD after a LSG. Some cases are caused by the large compliant stomach being transformed into a long and narrow tube. This implies a lack of gastric compliance, with an increased intraluminal pressure that correlates inversely with the diameter of the gastric tube and is increased when the pylorus is closed. Other factors are related to dismantling of the anatomical antireflux mechanisms, including disruption to the Hiss angle and resection of the sling fibers in the distal part of the lower sphincter, which results in low esophageal-sphincter pressure. The final shape of the sleeve also plays a role as it may favor GERD and regurgitation when it is funnel-shaped. Technical mistakes include narrowing at the junction between the vertical and horizontal parts of the sleeve, twisting of the sleeve, anatomical stenosis, and persistence of the gastric fundus and/or a HH that has not been diagnosed before surgery. The role of the gastric antrum has not been fully clarified but it is thought that extensive resection of the antrum may impair gastric empting and favor GERD).