Results of Longitudinal gastrectomy in treating diseases associated with obesity

Results of Longitudinal gastrectomy in treating diseases associated with obesity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Results of Longitudinal gastrectomy in treating diseases associated with obesity Abdul Rahman Hammadieh, Mohammad Oudeh, Rouaa AlAttar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3991671/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background & Objective: Laparoscopic gastric bypass surgery is one of the modern obesity operations that relies on the principle of size reduction. The doctors’ motivation behind performing this operation was to obtain better results than other operations, taking into account the costs. The goal of this study is to present the doctors’ experience in this operation. The surgical technique used, and the results they obtained while performing this operation to treat obese patients in Syria. Methods & Material A prospective study was carried out, following a laparoscopic gastric plication technique and was applied on 84 morbidly obese patients between February 2019 and September 2023. There were 14 men and70 women, with a mean age of 29.7 years (range18–65 years) and a mean body mass index of 39.5kg/m2 (range 32–49 kg/m2) superscripted. Results All operations were performed laparoscopically, The average surgical time was 82 minutes (53–175 minutes), and the average hospital stay was 35 hours (30 hours - four days), The average rate of return to usual activity after surgery 7 days (4–25 days), the leading weight loss rates were: 70%, 75%, 80%. 77%, 71%, 78% after: After 6, 12, 18, 24, 30, and 36 months, respectively, weight gain occurred in 4%, 7%, and 7.9% of patients after: 12, 24, and 36 months, respectively. Complications of surgery were: pneumonia, minor bleeding during surgery, vomiting, acute renal failure, pulmonary embolism, leakage, and infection. Conclusion Longitudinal sleeve gastrectomy is effective, safe, and acceptable to patients. It is a procedure with a higher rate of major medical problems than others. Its leading weight loss rate is higher than other size reduction operations. The cost of this operation is very high. General Surgery Bariatric Surgery Greater curvature plication Morbid obesity Vertical Sleeve Gastrectomy Restrictive procedure Figures Figure 1 Figure 2 Introduction Longitudinal gastrectomy is one of the traditional operations used to treat morbid obesity. This operation was first described by Hess in 1988 AD as part of biliary pancreatic diversion with duodenal switch (BPD-DS), and the first gastric sleeve operation was performed by Gagner in 1999 AD. Laparoscopic gastroplasty (LSG) was also used as a part of BPD-DS. Later, LSG was used as a staging procedure for morbid obesity and was finally used as an independent procedure. Since its first application in 2004 as an independent operation to treat obesity, LSG has proven to be sufficient and has become one of the most widely followed procedures. (1) Doctors use several factors to evaluate the results of obesity treatment, such as the percentage of excess weight loss, quality of life, and complications, including mortality after surgery. BAROS is considered the most important of them. BAROS refers to the evaluation of the percentage of excess weight loss, improvement and/or resolution of comorbid conditions, and five aspects of the quality of obesity treatment. Life (self-esteem, physical activity, social activity, work, sexual activity), complications, re-operations. (2) The final outcome is based on improvement, deterioration, or no change in all five areas listed, providing the most comprehensive assessment of treatment outcomes that not only affects weight changes but also their impact on the overall health of patients. The original indication for gastric sleeve surgery was in patients with of morbid obesity (BMI greater than 60) to induce weight loss. During the follow-up of these patients, a significant decrease in excess body weight was observed. Therefore, the gastric sleeve procedure is the easiest and safest compared to other surgical operations, and therefore the aim of the research is to evaluate the results. Laparoscopic sleeve gastrectomy used as a standalone procedure for morbid obesity. (3) Materials and methods This Prospective Cohort Study was conducted at Damascus University Hospitals in the General Surgery Department during the period between 2019–2023 AD, and included 84 patients (70 females and 14 males). The average age was about 33.7 years, meaning it ranged between 18–65 years. As for the average BMI It was 40.5 and ranged between 32–49 kg/m2 conducted routine blood tests and studied thyroid function for all patients, and a cardiac consultation was conducted for patients who suffer from accompanying diseases or who are over 40 years of age. I also conducted a glandular consultation for all patients, and an upper gastrointestinal endoscopy was also performed for patients who suffer from ulcer symptoms or symptoms of a hiatal hernia. Only (patients with ulcers and hiatal hernia were excluded from surgery), and the surgical technique and its near and distant complications were explained to the patients, and the possible results of this operation, and it was compared to other obesity operations, and it was confirmed that all patients had undergone non-surgical means to lose weight, and they did not obtain the results. The patients were not given oral anticoagulants before surgery, but rather a single dose of antibiotics was given to them half an hour before surgery. Surgery: Using the ACE Harmonic device (Ethicone Endo-Surgery\cincinnati\Ohio) separate the omentum from the greater curvature of the stomach starting 4–5 cm from the pylorus at the bottom until 2 cm before the angle of His. Locations of the trocars: The following figure shows the first 10 mm trocar on the line connecting the umbilicus and the xiphoid process, the point where the lower third meets the upper two thirds (30 D lens trocar), and the second 10 mm trocar in the left hypochondrium, 10 cm away from the previous trocar (the surgeon’s right hand). The third trocar is 5 mm in the left hypochondrium on the anterior axillary line (surgeon's assistant), the fourth trocar is 5 mm in the right hypochondrium on the midclavicular line (surgeon's left hand), the fifth trocar is 5 mm in the distal epigastrium to abduct the liver (in some cases only when there is difficulty After the operation, the patient is discharged from the hospital when he is able to tolerate clear liquids, so that the diet after surgery is: clear liquids in the first week and clear liquids rich in protein in the second week, ground (semi-solid) food in The third week, gradual introduction of solid foods in the fourth week. The patient is discharged on a prescription for a PPI for two months, low molecular weight heparin for a week starting the day after surgery, an antiemetic when needed, and an analgesic when needed. The patient is reviewed a week after surgery and then at months 1, 3, 6, 12, 18, and 24. .....After surgery. Patients who were not able to be contacted (medical visit or phone call) during the study period were excluded, provided that the follow-up period was not less than 6 months, and the maximum was 40 months. The study examined: the time of surgery, the time of stay in the hospital, complications after surgery, recovery or accompanying diseases related to obesity, and the amount of weight lost, expressed as excess weight loss. Statistical analysis: The data was completed from the forms into an Excel file, and special simple statistics were conducted. The results were summarized and explained with tables and charts. The Spss-28 statistics program was used, and descriptive statistics were reviewed based on percentages and graphical shapes, in addition to measures of central tendency (arithmetic mean and standard deviation. Results All operations were completed laparoscopically, there was no conversion to conventional open surgery, and the average operative time was 82 minutes (53–175 minutes). The average hospital stay was 35 hours (30 hours − 4 days), and 7 patients (8.3%) required readmission after discharge due to infusion, severe vomiting, and sepsis that disturbed electrolytes and acute renal failure (one case). Two patients (1.2%), sepsis occurred in 1.2%, pneumonia occurred in 5 patients (5.95%), and pulmonary embolus in 1 patient (1.2%). They all graduated without any complications after being given fluids and appropriate treatment. 10 patients (11.9%) required placement. Intravenous fluids at home for several days only. Postoperative vomiting induced 70 patients (83%) and lasted for an average of 4 days (1–21 days). Wound infection can be managed by giving broad-spectrum antibiotics, while the management of infusion was readmission and laparotomy. For some cases, for other cases, the detonator was sufficient. The rate of return to normal life (work, study....) was, after 5 days (6–8 days), two cases of moderate bleeding were recorded during the surgery, which were controlled, and during which we did not need to Blood transfusion (one from shortened gastric arteries and the other due to liver damage). One case of pulmonary embolism was recorded (the patient neglected to take anticoagulants after surgery) confirmed by CT. The patient was readmitted and treated and graduated after two weeks of treatment. Two cases of pneumonia were recorded and were treated with antibiotics without admission to the hospital, and one case of infection occurred and was treated with antibiotics. Two patients had a leak, and comorbidities related to obesity were found in 66 patients (78.5%). The rate of recovery was studied after 6 and 18 months. The study of patients’ excess weight loss was as follows: 70% after 6 months, 75% after 12 months, 80% after 18 months, 77% after 24 months, 71% after 30 months, 68% after 36 months Weight return occurred in 5 patients (5.9%) after 12 months, 6 (7.2%) patients after 24 months and 7 patients (8.3%) %) after 36 months. Discussion LSG is one of the most important bariatric surgeries and a new way for patients to lose excess weight. However, the surgical technique is advanced, well-established, and standardized [ 4 ]. There are few studies conducted to evaluate the results of gastric bypass operations, and researchers use multiple outcome measures and evaluation tools. Therefore, it is difficult to compare results [ 5 – 6 ]. The duration of operation was 82 minutes and hospital stay was 1.45 days in our study, which is shorter than in the recent study by Shi et al. In this study the results of 940 cases were summarized (100.4 minutes and 4.4 days, respectively) [ 6 ]. The percentage of males was (16.7%), while the percentage of females was (83.3%), where the percentage of males is less than the percentage of females, meaning that females are more likely to perform such operations, and the recovery rate of obese patients who developed diabetes was 6 months after performing a gastric bypass operation. The longitudinal rate was 6% and after 18 months was 8%, while the recovery rate for obese patients who suffered from high blood pressure 6 months after gastric bypass surgery was 4.5% and after 18 months was 5%, and the recovery rate for obese patients who suffered from back and knee pain 6 months after Performing a gastric bypass surgery was 18% and after 18 months was 21%, and the recovery rate for obese patients who suffered from hyperlipidemia 6 months after performing a gastric bypass was 4% and after 18 months was 5%, while the recovery rate for obese patients who suffered from respiratory arrest was During sleep, after 6 months, it was 2.1%, and after 18 months, it was 4.6%. It is assumed that the global impact of bariatric surgery is greater than just the percentage of excess weight loss. In our study, the average EWL percentage of 75% at 12 months, 80% at 18 months, and 77% at 24 months of follow-up is greater than the expected average of 60% and 65% for EWL. EWL at 12 and 24 months relative to the study conducted by Shi et al [ 6 ]. This is explained by poor adherence to postoperative recommendations that after recovery patients should exercise and should increase physical activity. According to the study conducted by Leifhitz et al., Increase physical activity to at least 30 minutes per day, three times per week, with a BMI reduction of up to 4% of the initial BMI [ 7 ]. Data collected during the study showed that the speed of weight loss in females is higher than the speed of weight loss in males or vice versa. Scientists have come to another conclusion that LSG as a standalone procedure is more effective in thin patients with a low initial BMI, but to prove this, it is necessary to To conduct more studies. A well-known positive outcome of metabolic surgery is the resolution or improvement of comorbid medical conditions [ 8 ]. Five common comorbidities were evaluated and were present in 78.5% (n = 66) of patients before surgery, and complete resolution of all comorbidities was observed 18 months after surgery. It is the same as achieved by Basso et al, in their large series of 300 cases of LSG [ 9 ]. The rate of surgical complications was high, with the most common complication being vomiting at 83%, compared to 12.1% in the study conducted by Shi et al [ 6 ] and 9% in the study conducted by Basu et al [ 7 ]. There are some uncommon late complications following malabsorption such as Anemia, hair loss and hypometabolism including deficiency of proteins and vitamins [ 10 ]. The study design did not allow identification of causative factors. The results of the study showed that the mortality rate was lower than the mortality rate in other LSG studies, 0.5% [ 8 ] and 0.3% [ 11 ]; However, surgery-related mortality decreases as doctors' experience in treating obesity increases. Conclusion Gastric bypass surgery is an effective size reduction surgery. Its benefits include: few complications that can be managed without major problems, ease of patient follow-up, no future nutritional disorders compared to bypass, and no foreign body. Also, the results of weight loss with EWL are acceptable and better than others.. It can be converted to another operation in the event of failure to lose weight, or the return of weight gain. Declarations Ethics approval and consent to participate: The Research Ethics Committee at the Levant Private University and the Ethics Committee at the University of Damascus approved the study protocol, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards. Similar. Consent for publication: Not applicable. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Conflict of interest: The authors declare that they have no conflict of interest Funding: This research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors. Authors’ contributions: R.A. conceptualized the study M.O wrote the study protocol, performed the statistical analysis, participated in data collection, M.O did the literature search and participated in the literature search, interpret the results, wrote the main manuscript A.H. revised the draft. All authors read and approved the final draft. Acknowledgments: We thank the administration of Al-Sham Private University for their support in the field of medical training and research. And the medical staff at Damascus Hospital. We would also like to thank Dr. Abdul Rahman Hammadieh for his assistance and supervision of the paper. References Till H, Blüher S, Hirsch W et al (2008) Efficacy of laparoscopic sleeve gastrectomy (lsg) as a stand-alone technique for children with morbid obesity. Obes Surg. ; Springer Buchwald H (2005) Bariatric surgery for morbid obesity: Healthimplications for patients, health professionals and third party payers. J Am Coll Surg 200:593–603 Marceau P, Cabanac M, Frankham PC et al (2005) Accelerated satiation after the duodenal switch. SOARD 1:408–412 Iannelli A, Dainese R, Piche T et al (2008) Laparoscopic sleeve gastrectomy for morbid obesity. World J Gastroenterol 14(6):821–827. 10.3748/wjg.14.821 [PMC free article] [PubMed] [CrossRef] [Google Scholar] Shi X, Karmali S, Sharma AM et al (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. 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Obes Surg 20:657–665. 10.1007/s11695-010-0096-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar] Alvarez-Leite JI (2004) Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care 7(5):569–575. 10.1097/00075197-200409000-00010 [PubMed] [CrossRef] [Google Scholar] Hammadieh AR Firas Safadi,Osama Shaheen, Laparoscopic Gastric Plication: Appropriate Option in Times of Crisis?, January 2017British J Med Med Res 19(3): 10.9734/BJMMR/2017/30714 Additional Declarations The authors declare potential competing interests as follows: no Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3991671","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275024890,"identity":"353660e4-30a0-45f6-b71f-7672f9c890ca","order_by":0,"name":"Abdul Rahman Hammadieh","email":"","orcid":"","institution":"Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Abdul","middleName":"Rahman","lastName":"Hammadieh","suffix":""},{"id":275024891,"identity":"5e22dd50-2643-40b0-9263-ae45e011d7e4","order_by":1,"name":"Mohammad Oudeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYFACHjDJuAFISDA2SMixsTcAmQYWRGuxMObjOQDSIkG0lorEeRIJIAHcWnTbew9+upljI7udvcfwxscdEoltks+vbvhRIMHA396dgE2L2ZlzydK529KMd/acMbaceUbCuE06p+xmD9BhEmfObsCq5UaOAVDL4cQNN3LMpHnbJGSBWtJu8AC1GEjk4tJi/Dt323+Ilr9tEoxtkmfSbv7Br8UMaMsBiBbGNgnFNgn2Y7fx2nLmjJl17rZkoF+OFVv2tkkYs/HksN2WMZDgwemX4z3Gt3O32QFDrHnjjZ9tdXLy7cef3Xzzx0aOv70XqxZsgMcATBKrHATYH5CiehSMglEwCoY/AAAU2GfT90mBJQAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Oudeh","suffix":""},{"id":275024892,"identity":"fdd32e80-c112-4c6e-8f57-59af7f3b4f45","order_by":2,"name":"Rouaa AlAttar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYLCCDxVgivEBkODhI0YH44wzDBI8DAzMBiAtbMRoYeZtA2thkwDxCGoxb29++IGHza7Onv3ss8qvOXYybAzMDx/dwKNF5swxYwkJnmQJHp50s9uy25KBDmMzNs7Bo0VCIsFAwkCCGeiwNLbbktuYgVp42KTxa0n//CPBoF6Ch/8ZW7HktnpitOSYSRxIOCzBI5HGxvhx22EitPCcKbNsOHBcsufGM2Zpxm3HediYCfmFvX3z7b//qvnZ+9MYP/7cVm3Pz9788DE+LSiAmQdMEqscBBh/kKJ6FIyCUTAKRgwAADAFPTFkPhI1AAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":true,"prefix":"","firstName":"Rouaa","middleName":"","lastName":"AlAttar","suffix":""}],"badges":[],"createdAt":"2024-02-26 18:24:14","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3991671/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3991671/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51718396,"identity":"93ddf034-5e67-40d4-9089-c9c9b40dbfbc","added_by":"auto","created_at":"2024-02-27 21:28:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33300,"visible":true,"origin":"","legend":"\u003cp\u003eLocation of the trocars in the process of longitudinal cutting of the stomach to prevent gastric damage\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3991671/v1/fbcbb254aa8c31ce56ab4973.png"},{"id":51718397,"identity":"2a371416-d8dd-4875-8434-a074e4e94269","added_by":"auto","created_at":"2024-02-27 21:28:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26310,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of excess weight loss during LGP surgery after 6, 12, 18, 24, 30 and 36 months\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3991671/v1/f729da28fab298281a5c7406.png"},{"id":51718398,"identity":"1615147d-1033-4c34-a472-907c37035096","added_by":"auto","created_at":"2024-02-27 21:28:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":263192,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3991671/v1/8a5a7689-79b0-4d74-ad2c-a1ccf11dac9e.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: no","formattedTitle":"\u003cp\u003e\u003cstrong\u003eResults of Longitudinal gastrectomy in treating diseases associated with obesity\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLongitudinal gastrectomy is one of the traditional operations used to treat morbid obesity. This operation was first described by Hess in 1988 AD as part of biliary pancreatic diversion with duodenal switch (BPD-DS), and the first gastric sleeve operation was performed by Gagner in 1999 AD. Laparoscopic gastroplasty (LSG) was also used as a part of BPD-DS. Later, LSG was used as a staging procedure for morbid obesity and was finally used as an independent procedure. Since its first application in 2004 as an independent operation to treat obesity, LSG has proven to be sufficient and has become one of the most widely followed procedures. (1)\u003c/p\u003e \u003cp\u003eDoctors use several factors to evaluate the results of obesity treatment, such as the percentage of excess weight loss, quality of life, and complications, including mortality after surgery. BAROS is considered the most important of them. BAROS refers to the evaluation of the percentage of excess weight loss, improvement and/or resolution of comorbid conditions, and five aspects of the quality of obesity treatment. Life (self-esteem, physical activity, social activity, work, sexual activity), complications, re-operations. (2)\u003c/p\u003e \u003cp\u003eThe final outcome is based on improvement, deterioration, or no change in all five areas listed, providing the most comprehensive assessment of treatment outcomes that not only affects weight changes but also their impact on the overall health of patients. The original indication for gastric sleeve surgery was in patients with of morbid obesity (BMI greater than 60) to induce weight loss. During the follow-up of these patients, a significant decrease in excess body weight was observed. Therefore, the gastric sleeve procedure is the easiest and safest compared to other surgical operations, and therefore the aim of the research is to evaluate the results. Laparoscopic sleeve gastrectomy used as a standalone procedure for morbid obesity. (3)\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis Prospective Cohort Study was conducted at Damascus University Hospitals in the General Surgery Department during the period between 2019\u0026ndash;2023 AD, and included 84 patients (70 females and 14 males). The average age was about 33.7 years, meaning it ranged between 18\u0026ndash;65 years. As for the average BMI It was 40.5 and ranged between 32\u0026ndash;49 kg/m2 conducted routine blood tests and studied thyroid function for all patients, and a cardiac consultation was conducted for patients who suffer from accompanying diseases or who are over 40 years of age. I also conducted a glandular consultation for all patients, and an upper gastrointestinal endoscopy was also performed for patients who suffer from ulcer symptoms or symptoms of a hiatal hernia. Only (patients with ulcers and hiatal hernia were excluded from surgery), and the surgical technique and its near and distant complications were explained to the patients, and the possible results of this operation, and it was compared to other obesity operations, and it was confirmed that all patients had undergone non-surgical means to lose weight, and they did not obtain the results. The patients were not given oral anticoagulants before surgery, but rather a single dose of antibiotics was given to them half an hour before surgery.\u003c/p\u003e \u003cp\u003eSurgery: Using the ACE Harmonic device (Ethicone Endo-Surgery\\cincinnati\\Ohio) separate the omentum from the greater curvature of the stomach starting 4\u0026ndash;5 cm from the pylorus at the bottom until 2 cm before the angle of His.\u003c/p\u003e \u003cp\u003eLocations of the trocars: The following figure shows the first 10 mm trocar on the line connecting the umbilicus and the xiphoid process, the point where the lower third meets the upper two thirds (30 D lens trocar), and the second 10 mm trocar in the left hypochondrium, 10 cm away from the previous trocar (the surgeon\u0026rsquo;s right hand). The third trocar is 5 mm in the left hypochondrium on the anterior axillary line (surgeon's assistant), the fourth trocar is 5 mm in the right hypochondrium on the midclavicular line (surgeon's left hand), the fifth trocar is 5 mm in the distal epigastrium to abduct the liver (in some cases only when there is difficulty After the operation, the patient is discharged from the hospital when he is able to tolerate clear liquids, so that the diet after surgery is: clear liquids in the first week and clear liquids rich in protein in the second week, ground (semi-solid) food in The third week, gradual introduction of solid foods in the fourth week.\u003c/p\u003e \u003cp\u003eThe patient is discharged on a prescription for a PPI for two months, low molecular weight heparin for a week starting the day after surgery, an antiemetic when needed, and an analgesic when needed. The patient is reviewed a week after surgery and then at months 1, 3, 6, 12, 18, and 24. .....After surgery. Patients who were not able to be contacted (medical visit or phone call) during the study period were excluded, provided that the follow-up period was not less than 6 months, and the maximum was 40 months.\u003c/p\u003e \u003cp\u003eThe study examined: the time of surgery, the time of stay in the hospital, complications after surgery, recovery or accompanying diseases related to obesity, and the amount of weight lost, expressed as excess weight loss.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe data was completed from the forms into an Excel file, and special simple statistics were conducted. The results were summarized and explained with tables and charts. The Spss-28 statistics program was used, and descriptive statistics were reviewed based on percentages and graphical shapes, in addition to measures of central tendency (arithmetic mean and standard deviation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll operations were completed laparoscopically, there was no conversion to conventional open surgery, and the average operative time was 82 minutes (53\u0026ndash;175 minutes). The average hospital stay was 35 hours (30 hours \u0026minus;\u0026thinsp;4 days), and 7 patients (8.3%) required readmission after discharge due to infusion, severe vomiting, and sepsis that disturbed electrolytes and acute renal failure (one case). Two patients (1.2%), sepsis occurred in 1.2%, pneumonia occurred in 5 patients (5.95%), and pulmonary embolus in 1 patient (1.2%). They all graduated without any complications after being given fluids and appropriate treatment. 10 patients (11.9%) required placement. Intravenous fluids at home for several days only. Postoperative vomiting induced 70 patients (83%) and lasted for an average of 4 days (1\u0026ndash;21 days). Wound infection can be managed by giving broad-spectrum antibiotics, while the management of infusion was readmission and laparotomy. For some cases, for other cases, the detonator was sufficient. The rate of return to normal life (work, study....) was, after 5 days (6\u0026ndash;8 days), two cases of moderate bleeding were recorded during the surgery, which were controlled, and during which we did not need to Blood transfusion (one from shortened gastric arteries and the other due to liver damage).\u003c/p\u003e \u003cp\u003eOne case of pulmonary embolism was recorded (the patient neglected to take anticoagulants after surgery) confirmed by CT. The patient was readmitted and treated and graduated after two weeks of treatment. Two cases of pneumonia were recorded and were treated with antibiotics without admission to the hospital, and one case of infection occurred and was treated with antibiotics.\u003c/p\u003e \u003cp\u003eTwo patients had a leak, and comorbidities related to obesity were found in 66 patients (78.5%). The rate of recovery was studied after 6 and 18 months. The study of patients\u0026rsquo; excess weight loss was as follows: 70% after 6 months, 75% after 12 months, 80% after 18 months, 77% after 24 months, 71% after 30 months, 68% after 36 months Weight return occurred in 5 patients (5.9%) after 12 months, 6 (7.2%) patients after 24 months and 7 patients (8.3%) %) after 36 months.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLSG is one of the most important bariatric surgeries and a new way for patients to lose excess weight. However, the surgical technique is advanced, well-established, and standardized [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. There are few studies conducted to evaluate the results of gastric bypass operations, and researchers use multiple outcome measures and evaluation tools. Therefore, it is difficult to compare results [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe duration of operation was 82 minutes and hospital stay was 1.45 days in our study, which is shorter than in the recent study by Shi et al. In this study the results of 940 cases were summarized (100.4 minutes and 4.4 days, respectively) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe percentage of males was (16.7%), while the percentage of females was (83.3%), where the percentage of males is less than the percentage of females, meaning that females are more likely to perform such operations, and the recovery rate of obese patients who developed diabetes was 6 months after performing a gastric bypass operation. The longitudinal rate was 6% and after 18 months was 8%, while the recovery rate for obese patients who suffered from high blood pressure 6 months after gastric bypass surgery was 4.5% and after 18 months was 5%, and the recovery rate for obese patients who suffered from back and knee pain 6 months after Performing a gastric bypass surgery was 18% and after 18 months was 21%, and the recovery rate for obese patients who suffered from hyperlipidemia 6 months after performing a gastric bypass was 4% and after 18 months was 5%, while the recovery rate for obese patients who suffered from respiratory arrest was During sleep, after 6 months, it was 2.1%, and after 18 months, it was 4.6%.\u003c/p\u003e \u003cp\u003eIt is assumed that the global impact of bariatric surgery is greater than just the percentage of excess weight loss. In our study, the average EWL percentage of 75% at 12 months, 80% at 18 months, and 77% at 24 months of follow-up is greater than the expected average of 60% and 65% for EWL. EWL at 12 and 24 months relative to the study conducted by Shi et al [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This is explained by poor adherence to postoperative recommendations that after recovery patients should exercise and should increase physical activity. According to the study conducted by Leifhitz et al., Increase physical activity to at least 30 minutes per day, three times per week, with a BMI reduction of up to 4% of the initial BMI [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData collected during the study showed that the speed of weight loss in females is higher than the speed of weight loss in males or vice versa. Scientists have come to another conclusion that LSG as a standalone procedure is more effective in thin patients with a low initial BMI, but to prove this, it is necessary to To conduct more studies.\u003c/p\u003e \u003cp\u003eA well-known positive outcome of metabolic surgery is the resolution or improvement of comorbid medical conditions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Five common comorbidities were evaluated and were present in 78.5% (n\u0026thinsp;=\u0026thinsp;66) of patients before surgery, and complete resolution of all comorbidities was observed 18 months after surgery. It is the same as achieved by Basso et al, in their large series of 300 cases of LSG [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe rate of surgical complications was high, with the most common complication being vomiting at 83%, compared to 12.1% in the study conducted by Shi et al [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and 9% in the study conducted by Basu et al [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There are some uncommon late complications following malabsorption such as Anemia, hair loss and hypometabolism including deficiency of proteins and vitamins [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The study design did not allow identification of causative factors.\u003c/p\u003e \u003cp\u003eThe results of the study showed that the mortality rate was lower than the mortality rate in other LSG studies, 0.5% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and 0.3% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; However, surgery-related mortality decreases as doctors' experience in treating obesity increases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGastric bypass surgery is an effective size reduction surgery. Its benefits include: few complications that can be managed without major problems, ease of patient follow-up, no future nutritional disorders compared to bypass, and no foreign body. Also, the results of weight loss with EWL are acceptable and better than others.. It can be converted to another operation in the event of failure to lose weight, or the return of weight gain.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee at the Levant Private University and the Ethics Committee at the University of Damascus approved the study protocol, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards. Similar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this paper\u0026rsquo;s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from ASPU or any other funding agency in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.A.\u0026nbsp;conceptualized the study M.O wrote the study protocol, performed the statistical analysis, participated in data collection, M.O did the literature search and participated in the literature search, interpret the results, wrote the main manuscript A.H. revised the draft. All authors read and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the administration of Al-Sham Private University for their support in the field of medical training and research. And the medical staff at Damascus Hospital. We would also like to thank Dr. Abdul Rahman Hammadieh for his assistance and supervision of the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTill H, Bl\u0026uuml;her S, Hirsch W et al (2008) Efficacy of laparoscopic sleeve gastrectomy (lsg) as a stand-alone technique for children with morbid obesity. Obes Surg. ; Springer\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuchwald H (2005) Bariatric surgery for morbid obesity: Healthimplications for patients, health professionals and third party payers. 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Curr Opin Clin Nutr Metab Care 7(5):569\u0026ndash;575. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00075197-200409000-00010\u003c/span\u003e\u003cspan address=\"10.1097/00075197-200409000-00010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e[PubMed] [CrossRef] [Google Scholar]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammadieh AR Firas Safadi,Osama Shaheen, Laparoscopic Gastric Plication: Appropriate Option in Times of Crisis?, January 2017British J Med Med Res 19(3): \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.9734/BJMMR/2017/30714\u003c/span\u003e\u003cspan address=\"10.9734/BJMMR/2017/30714\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"2d704159-3683-426f-8955-4c573fdaa24b","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0996066591","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bariatric Surgery, Greater curvature plication, Morbid obesity, Vertical Sleeve Gastrectomy, Restrictive procedure","lastPublishedDoi":"10.21203/rs.3.rs-3991671/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3991671/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u0026amp; Objective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLaparoscopic gastric bypass surgery is one of the modern obesity operations that relies on the principle of size reduction. The doctors’ motivation behind performing this operation was to obtain better results than other operations, taking into account the costs. The goal of this study is to present the doctors’ experience in this operation. The surgical technique used, and the results they obtained while performing this operation to treat obese patients in Syria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u0026amp; Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective study was carried out, following a laparoscopic gastric plication technique and was applied on 84 morbidly obese patients between February 2019 and September 2023. There were 14 men and70 women, with a mean age of 29.7 years (range18–65 years) and a mean body mass index of 39.5kg/m2 (range 32–49 kg/m2) superscripted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll operations were performed laparoscopically, The average surgical time was 82 minutes (53–175 minutes), and the average hospital stay was 35 hours (30 hours - four days), The average rate of return to usual activity after surgery 7 days (4–25 days), the leading weight loss rates were: 70%, 75%, 80%. 77%, 71%, 78% after: After 6, 12, 18, 24, 30, and 36 months, respectively, weight gain occurred in 4%, 7%, and 7.9% of patients after: 12, 24, and 36 months, respectively. Complications of surgery were: pneumonia, minor bleeding during surgery, vomiting, acute renal failure, pulmonary embolism, leakage, and infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLongitudinal sleeve gastrectomy is effective, safe, and acceptable to patients. It is a procedure with a higher rate of major medical problems than others. Its leading weight loss rate is higher than other size reduction operations. The cost of this operation is very high.\u003c/p\u003e","manuscriptTitle":"Results of Longitudinal gastrectomy in treating diseases associated with obesity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-27 21:28:03","doi":"10.21203/rs.3.rs-3991671/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"964ba9f1-8fc4-47e7-af1d-ef13a8f3ef8b","owner":[],"postedDate":"February 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28984227,"name":"General Surgery"}],"tags":[],"updatedAt":"2024-02-27T21:28:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-27 21:28:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3991671","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3991671","identity":"rs-3991671","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}