Background Laparoscopic sleeve gastrectomy (LSG) has gained acceptance worldwide. However, SG has its own complications that need a specialized management. Omentopexy is a technique in which the sleeved part of the stomach is fixed to the greater omentum. Aim of the Study The present work aimed to investigate the potential effect of omentopexy on the upper GIT disturbances in patients with severe obesity and undergoing LSG. Patients and Methods This study included patients who were recruited for LSG in our institution from June 2019 to October 2020. Patients having no upper GIT symptoms, no esophagogastroduodenoscopy (EGD) GERD signs, and no hiatus hernia were eligible for the study. Patients were randomly enrolled into the omentopexy group (underwent LSG with omentopexy) and the non-omentopexy group (underwent LSG only). Patients were followed up 1 month, 3 months, and 1 year after the operation. EGD was performed at the 1-year follow-up. Results Forty-five patients constituted the omentopexy group and forty-six constituted the non-omentopexy group. Omentopexy was associated with significant reduction in the early post LSG upper GIT symptoms, and less EGD evident reflux esophagitis at the 1-year follow-up (statistically non-significant). Conclusion The current work adds a new evidence of the omentopexy benefits in patients undergoing sleeve gastrostomy, with an overall better outcome in regard to the upper GIT upset and GERD compared to LSG alone. Graphical abstract

Background Obesity is a risk factor for chronic kidney disease and albuminuria. Despite the well-documented obesity association with diabetes mellitus and hypertension, its predisposition to albuminuria is not related to these comorbidities, and, in some times, its occurrence is independent of DM or hypertension. Purpose of the study The present study aimed to evaluate bariatric surgery effect on albuminuria in patients with severe obesity with no DM or hypertension. Materials and methods The study consisted of 137 patients with extreme obesity and albuminuria scheduled for bariatric surgery and did not have diabetes or hypertension. They underwent an assessment for 24-h urinary albumin at baseline (T0) and 6 months postoperatively (T2). Results Albuminuria remission occurred in 83% of patients; there was a statistically highly significant difference between the baseline and the 6-month postoperative in the 24-h urinary albumin assessment. Weight loss and BMI at T2 were independent predictors of albuminuria remission. Conclusion The current work emphasizes the importance and promising role of bariatric surgery as an effective weight reduction management method in improving albuminuria, an early sign of chronic kidney disease, and a potential risk factor for cardiovascular disease.

Background Sleeve gastrectomy (SG) continues to be one of the most popular bariatric procedures all over the world. Thyroid-stimulating hormone (TSH) frequently shows a slight elevation in patients with obesity. The effect of SG on thyroid hormones has been rarely investigated. Aim of the Study This study aimed to assess the short-term effect of SG on thyroid functions in Egyptian patients with morbid obesity and the potential predictors of the postoperative thyroid functions. Patients and Methods This study included patients undergoing SG at kasr al ainy hospitals. The patients underwent preoperative 3-, 6-, and 12-month postoperative analyses of the thyroid functions and other biochemical markers. Results The study included 106 patients who showed significant improvement in thyroid functions at the follow-up assessment. Twelve-month TSH positively correlated with the 12-month measures of LDL and HbA1c. TSH change at 12-month follow-up (TSH) was inversely correlated to 12-month BMI and positively correlated to preoperative TSH and 12-month percentage of total weight loss (TWL%). Univariable linear regression analysis demonstrated that preoperative TSH (p < 0.001), 12-month TWL% (p = 0.042), 12-month HbA1c (p = 0.001), and 12-month LDL (p = 0.049) were significant predictors for the 12-month TSH levels. Multivariable analysis showed that only preoperative TSH levels (p < 0.001) and 12-month HbA1c levels (p = 0.021) could affect the 12-month TSH levels. Conclusion The current study supports the evidence of thyroid function improvement after sleeve gastrectomy. This improvement was affected by the amount of weight loss after surgery.

Background: Laparoscopic cholecystectomy (LC) continues to be more evolving. Pain remains the main annoying symptom postoperative.Objectives: This study aimed to proof if using incentive spirometry (IS) after LC will alleviate tip shoulder and right hypochondrial pain. Patients and Methods: On 90 patients undergoing LC at Kasr Al ainy hospitals and National Hepatology and Tropical Medicine Research Institute (NHTMRI) who were identified as having chronic calcular cholecystitis clinically and radiographically by ultrasonography, a prospective randomized controlled research was conducted. Two groups are formed. Group I (n = 45) receiving IS (consisting of 20 slow, deep breaths with a spirometry while sitting or semi sitting every 2 hours beginning at 2 hours postoperative) . There will be no respiratory over activity in Group II (n = 45). The "Visual Analogue Scale" (VAS) score used to further analyses shoulder and right hypochondrial pain. Results: Group I average pain score was significantly lower than Group II average pain score at 2 hours, 4 hours, and 6 hours (p-value 0.001), as well as at 8 hours (pvalue =0.007). However, there were no significant differences between the study group and the control group on the second postoperative day (p-value = 0.900). In comparison to the control group, the study group receives a significantly lower dose of an analgesic (p-value 0.001). Conclusion: IS can be used routinely post LC at first day postoperative alleviating shoulder and right hypochondrial pain also decreasing analgesics requirement postoperative.

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