الفهرس 
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Abstract
This prospective randomized comparative study was carried out at Gastrointestinal and laparoscopic surgery unit, General Surgery Department, Tanta University Hospitals, during the period from October 2020 to October 2022 and included 40 morbidly obese patients who accepted to participate in the study and signed an informed consent. Patients were randomly assigned into 2 equal groups by the closed envelope method: - group A: included 20 patients who were submitted to laparoscopic Rouxen- Y gastric bypass (RYGB). - group B: included 20 patients who were submitted to laparoscopic single anastomosis sleeve-ileal bypass (SASI). • Inclusion criteria: o Age 18-60 years old. o Morbid obese patients with BMI ≥ 50 kg\m2 with or without comorbidities. • Exclusion criteria: 1. Surgically unfit patients as compromised cardiopulmonary function, liver cirrhosis, etc. 2. Mentally unstable patients. 3. Secondary obese patients caused by hormonal disorders as hypothyroidism or Cushing’s syndrome. 4. Drug and/or alcohol abuse patients. 5. Pregnant females. 6. Patients with history of malignant conditions. Aim of the study: The aim of this work was to compare laparoscopic Roux-en-Y gastric bypass (REYGB) versus single anastomosis sleeve-ileal (SASI) bypass, regarding to operative time, weight reduction, improvement of co-morbidities, complications, cost and effects on patients’ quality of life (QOL). The age characteristics of both study groups showed that the mean age of group I was 39.20 ± 6.56 years, compared to 34.75 ± 7.91 in group II, without a statistically significant difference between both groups. There were 4 males (20%) and 16 females (80%) in group I, while there were 5 males (25%) and 15 females (75%) in group II, no statistically significant difference was found in gender between both study groups In our study, there was no statistical significant difference between the two groups as regard the anthropometric measurements (weight, BMI, EBW, WC and the W/H ratio). The mean preoperative weight was 140.50 ± 18.50 kg vs. 150.35 ± 22.76 kg for group I and II respectively. The mean preoperative BMI was 60.06 ± 5.02 kg\m2 vs. 57.81 ± 7.06kg\m2 for group I and II respectively. The mean preoperative EBW was 84.80 ± 12.83 kg vs. 88.46 ± 18.62 kg for group I and II respectively. The mean preoperative WC was 133.10 ± 8.39 cm vs. 129.55 ± 6.19 cm for group I and II respectively. The most prevalent co-morbidities were musculoskeletal (knee pain, low back pain and osteoarthritis), dyslipidemia (elevated cholesterol, triglycerides, LDL and decreased HDL), hypertension, T2DM, and pseudotumor cerebri. Patient complaining of OSA were assessed by STOP-BANG questionnaire which showed 10 patients in group I and 9 patients in group II had score ≥ 3 The difference between the two study groups was statistically insignificant regarding these preoperative associated comorbidities. Preoperative endoscope of our patients revealed pathological findings in 15 patients (37.5%) in both groups; 6 in group I and 9 in group II, the commonest disorder was chronic gastritis of different degrees in 7 patients (46.6%) followed by small sliding hiatal hernia in 5 patients (33.3%) then Antral ulcers in 2 patients (13.3%) and reflux esophagitis in 1 patients (6.6%). Patients with lesions like gastritis, Antral ulcers and chronic helicobacter pylori infection received medical treatment for their lesions and proved to be cured endoscopically prior to be submitted to surgery. The mean operative time was 194.25 ± 27.11 minutes and 153.15 ± 23.74 minutes in group I and II respectively and the difference was found statistically significant. The intraoperative complications in this study included: superficial liver injury occurred in 5 patients (12.5%); 3 patients (15%) in group I and 2 patients (10%) in group II. A staple line bleeding occurred in 3 patients (7.5%); 1 patient (5%) in group I and 2 patients (10%) in group II that was managed using clips. A stapler misfire occurred in one patient in group II, twisting of sleeved stomach occurred in one patient in group II discovered with methylene blue test and Stenosis of gastrojejunal anastomosis (anastomosis technical problems) occurred in one patient of group I that need intraoperative revision of the anastomosis. In addition to the bariatric procedure, laparoscopic cholecystectomy was done in 4 patients (20%) in group I and 3 patients (15%) in group II due to presence of gall stones and open mesh repair of small paraumbilical hernia (2cm) was done in one patient (5 %) in group II. Regarding the early postoperative complications (within 30 days from the operation); Port site infection occurred in 2 patients in each group, also one patient in group II developed wound abscess. Fever due to lung atelectasis in the first 2 days postoperative presented in 2 patients (10%) in group I and 3 patients (15%) in group II. Only one patient (5%) in group I presented with blood tinged vomiting and refusing of feeding that was readmitted and was managed medically with good response. During follow up the late post-operative complications and sequelae were: Port site hernia occurred 2 months post-operatively in one patient (5%) in group II at the midline supraumbilical port. Six patients (18.18%) developed gall stones at a period from 3 to 12 months post-operatively 3 patients in each group, GERD symptoms were experienced by 2 patients in group I and responded well to regular PPIs therapy. Dumping syndrome presented in 5 patients (12.5%); 2 patients (10%) in group I and 3 patients (15%) in group II and successfully managed conservatively. Biliary reflux and gastritis occurred in 1patients (5%) in group II diagnosed clinically and by endoscopic findings during follow up, Stenosis of sleeved stomach presented in one patient (5%) in group II and was presented one month postoperative with frequent vomiting, diagnosed by CT with contrast and upper gastrointestinal endoscope. In regard to nutritional parameters during the postoperative follow-up period: There was an increase in the incidence of mild anemia and hypocalcaemia in group II than in group I. Severe malnutrition developed in 3 patients (15%) in group II presented to us after one year with severe anemia, hypoalbuminemia, elevated liver enzymes and ascites, these tree patients were readmitted in our unit. Our results revealed that LSASI produced significantly more weight loss than LRYGB over the period of the study where after one years of follow up, %EWL in group II was 60.71 ± 7.99 while in group I, it was 56.65 ± 2.08. Postoperatively during the follow up period till the end of the study, the achieved weight reduction produced beneficial effects on the associated comorbidities that showed either resolution or improvement of the co-morbidities. RYGB with long BPL achieved remission or improvement in 83% of patients with DM and the rate of improvement in DM after SASI bypass in our study was 80%, Regarding hypertension remission, The rate of improvement in hypertension in our study was 71% in RYGB group and more than 95% in SASI group, Referring to the remission rate of dyslipidaemia our results were 05% and 71.4% in group I and II respectively. Our study confirm the results of related studies that bariatric surgery is the most effective method of weight reduction in morbid obesity and maintenance of weight lost. It is beneficial to perform other studies on larger number of patients for longer follow up periods.