Back ground: The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality.The aim of study: to evaluate serum ghrelin levels achieved through LSG and on insulin resistance and the serial changes of insulin concentration in obese patients following gastric sleeve.Patients and methods: twenty four patients underwent LSG with 25 controls were selected. Body mass index (BMI), waist circumference (WC), lipid profile, fasting blood sugar (FBS), glycated hemoglobin (HbA1c), fasting insulin, QUICKI and ghrelin hormone concentrations were measured for controls and patients prior LSG, then one month and three months post-surgery.Results: A significant decline was noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and ghrelin, with significant increase in QUICKI in patients undergone LSG with significant differences in all studied parameters between patients and controls. A negative correlation was noticed between ghrelin and BMI in patients before sleeve gastrectomy.Conclusion: Ghrelin is a hormone closely linked with obesity taking into account the marked loss in appetite in the period after laparoscopic sleeve gastrectomy.

Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi- organ failure.Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes.Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients.Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2 ), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortalityConclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.

Background: Obesity is a global health issue. Laparoscopic sleeve gastrectomy has progressively become the most popular procedure among the surgical community as a definitive bariatric operation. The increasing number of surgeries performed will be likely be followed by increasing reports of patients experiencing weight loss failure.Objectives: To determine the effectiveness of conversion from laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass in cases with weight loss failure.Patient &methods: The retrospective review of patients who had operated with laparoscopic sleeve gastrectomy from October 2009 to January 2016 at Saint Raphael hospital, 21 patients included in this study had insufficient weight loss after Sleeve Gastrectomy and converted to Roux-en-Y gastric bypass.Results: Fifteen patients (71.4%) had LSG as their single bariatric operation before conversion to roux en Y gastric bypass, 2 patients (9.5%) had Intragastric balloon and 4 (19.1%) patients had the laparoscopic adjustable gastric band before to their sleeve gastrectomy. Fourteen patients (66.6%) were female and 7 (33.4%) were males, At 6, 12, 18 months after bypass ,mean BMI was 37.2 (32.7-44.3),32.5(28.7-39.1) and 30.2 kg/m2 (24.3-37.9 kg/m2) respectively , reflecting a %EWL (percentage weight loss) at 18 month of 61.7%.Conclusion: insufficient weight loss after Sleeve Gastrectomy can be safely and effectively treated by conversion to Roux-en-Y gastric bypass to control weight loss failure or weight regain.Keywords: weight loss failure, weight regain, failed Sleeve Gastrectomy.

Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi-organ failure. Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes. Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients. Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortality Conclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.

Background: Laparoscopic colectomy is performed in an increasing number of institutions as a minimally invasive treatment for benign and malignant large bowel disease. Laparoscopic rectal surgery enables more accurate visualization of the anatomical structure in the pelvic cavity for selected patients with tumors in the middle and low rectum.Objectives: To determine the early outcome of patient who underwent laparoscopic low anterior resection using radial reload stapler.Patients and methods: This is a prospective study of 8 patients with low or mid rectal cancer who underwent a laparoscopic low anterior resection between January 2017 till June 2017 at Saint Raphael hospital.Results: Eight patients underwent elective laparoscopic low anterior resection, 5 (62.5%) of them were male and 3(37.5%) were female. In 6 (75%) patients complete rectal transaction done only radial reload stapler, while the other 2 (25%) patients complete transaction couldn’t be done only by the radial reload stapler and they need one Endo GIATM (Covidien) medium thick purple stapler. There was no anastomotic leakage, no wound infection and no mortality.Conclusion: The primary results and early outcome of this study showed that laparoscopic low anterior resection using radial reload is a safe procedure without increasing the risk of anastomotic leak. Further analysis in a large series is needed to draw definitive conclusions.