Main Article Content

Madiha Mahmoud
Raghad Saoud E Alhawiti
Taif Abdullhakim M Salamah
Ahmed G Abdelaziz
Sherif Gad Abdelaziz


Keywords: Bariatric Surgery, Gastric sleeve surgery, Obesity, Comorbidity, Advantages, complications, Saudi Arabia, Egypt.


Background: Gastric sleeve surgery (GSS) is one of bariatric surgeries that improve obesity related comorbidities and more efficient than pharmacotherapy or lifestyle interventions.  Aim: To estimate the benefits of GSS and the complications in patients among Saudis and Egyptians.  Methods: A retrospective study was carried out among patients in Saudi Arabia and Egypt who underwent GSS, through interview with these patients postoperative. The interview questions were about Scio-demographic, advantages &disadvantages of GSS, obesity and comorbidity. Results: The total number of patients who underwent GSS was 426 who completed their data. About 182(42.7%) from KSA and 244(57.3%) from Egypt. Good results were observed in weight loss by 92.3% Vs 78.6%, control of diabetes (57.1% Vs 23.8%), control of lipid profile (62.6% Vs 49.2%), control of heart problem (45.1% Vs 18.9%), increased the fitness (79.1% Vs 43.4%), better social communication (57.1% Vs 73.8%), improve the ability to work (54.9% Vs 32.0%). On the other hand, our patients were suffering from acute & chronic complications due to gastric sleeve surgery such as bleeding by 30.8% Vs 31.9% (which is more predominant) followed by anaemia & Iron deficiency, stomach twisting, reduction in gastric juice, and pulmonary embolism among Saudi Vs Egyptian patients respectively. Weight gain was observed 2 and 3 years after GSS. Conclusion: The degree of satisfaction with GSS was higher in Saudis (67.0%) more than Egyptians (44.3%), and the benefits were more than complications, so, we advise to undergo GSS in obese patient who having more comorbidity due to obesity.



Abstract 315 | pdf Downloads 220


1. Abarca‑Gomez L, Abdeen ZA, Hamid ZA, Abu‑Rmeileh NM, costa‑Cazares B. NCD Risk Factor Collaboration (NCD‑RisC). Worldwide trends in body‑mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population‑based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017;390:2627‑42.:doi.org/10.1016/S0140-6736(17)32129-3
2. Abd Ellatif ME, Abdallah E, Askar W, Thabet W, Aboushady M, Abbas AE. Long term predictors of success after laparoscopic sleeve gastrectomy. Int J Surg. 2014;12(5):504-8. doi: 10.1016/j.ijsu.2014.02.008.
3. Aboulghate M, Elaghoury A, Elebrashy I, Elkafrawy N, Elshishiney G, Ehab Abul-Magd6 E, Engy Bassiouny E, Dalia Toaima D, Baher Elezbawy B, Fasseeh A, Abaza S, Vokó Z. The Burden of Obesity in Egypt. Frontiers in Public Health. 2021; 9: doi: 10.3389/fpubh.2021.718978.
4. Alfadda AA, Al Qarni A, Alamri K, Ahamed SS, Abo’ouf SM, Shams M, et al. Perceptions, attitudes, and barriers toward obesity management in Saudi Arabia: data from the ACTION-IO study. Saudi J Gastroenterol. 2021;27(3):166–172. doi: 10.4103/sjg.sjg_500_20
5. Alfadda AA, Al‑Dhwayan MM, Alharbi AA, Al Khudhair BK, Al Nozha OM, Al‑Qahtani NM, et al. The Saudi clinical practice guideline for the management of overweight and obesity in adults. Saudi Med J 2016;37:1151‑62. doi: 10.15537/smj.2016.10.14353
6. Al-Hajj GN, Haddad J. Preventing staple-line Leak in sleeve gastrectomy: Reinforcement with bovine pericardium vs oversewing, Obes. Surg. 2013;23(11):1915-1921. DOI: 10.1007/s11695-013-1062-4
7. AlMarri F, Al Sabah S, Al Haddad E, Vaz JD. A call for more research from the Arabian Gulf. Obes Surg 2017;27:2034‑43. doi: 10.1007/s11695-017-2588-7.
8. Alotaibi AA, Almutairy AN, Alsaab AS. Post-Bariatric Surgery Patients: A Quality of Life Assessment in Saudi Arabia. Cureus. 2022;14(4):e24273. doi: 10.7759/cureus.24273
9. Alsulami S, Baig M, Ahmad T, Nouf Althagafi N, Hazzazi E, Alsayed R, Majd Alghamdi M, Almohammadi T. Obesity prevalence, physical activity, and dietary practices among adults in Saudi Arabia. Front Public Health. 2023;11:1124051. doi: 10.3389/fpubh.2023.1124051.
10. Althumiri NA, Basyouni MH, Almousa N, Aljuwaysim MF, Almubark RA, Bindhim NF, et al. Obesity inSaudi Arabia in 2020: prevalence prevalence, distribution, and its current association with various health conditions. Healthcare (Basel). 2021;9(3):311. doi.org/10.3390/healthcare9030311.
11. Amin BK, Hassan KI. Molecular typing of human Brucella melitensis isolated from patients in Erbil, Iraq, ARO-THE Sci. J. KOYA Univ. 2019;7(1):1–4. doi.org/10.14500/aro.10306
12. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014; 27;349:g3961. doi: 10.1136/bmj.g3961
13. Ay L, Kopp HP, Brix JM, Ay C, Quehenberger P, Schernthaner GH. Thrombin generation in morbid obesity: significant reduction after weight loss, J Thromb Haemost. 2010;8(4):759-65. doi:10.1111/j.1538-7836.2010.03766.x.
14. Balhareth A, Meertens R, Kremers S, Sleddens E. Overweight and obesity among adults in the Gulf States: a systematic literature review of correlates of weight, weight-related behaviours, and interventions. Obes Rev. 2019;20(5):763–793. doi: 10.1111/obr.12826.
15. Booth H, Khan O, Prevost AT, Reddy M, Charlton J, Gulliford MC. Impact of bariatric surgery on clinical depression. Interrupted time series study with matched controls, J Affect Disord. 2015;174:644-9. doi: 10.1016/j.jad.2014.12.050.
16. Bout-Tabaku S, Gupta R, Jenkins TM, Ryder JR, Baughcum AE, Jackson RD. Musculoskeletal pain, physical function, and quality of life after bariatric surgery, Pediatrics. 2019;144(6):e20191399. doi: 10.1542/peds.2019-1399.
17. Brunault P, Jacobi D, Miknius V, Bourbao-Tournois C, Huten N, Gaillard P. High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study. Psychosomatics. 2012;53(4):363-70. doi: 10.1016/j.psym.2011.12.008.
18. Catheline J-M, Fysekidis M, Dbouk R, Boschetto A, Bihan H, Reach G. Weight loss after sleeve gastrectomy in super superobesity, J. Obes.2012;959260. DOI: 10.1155/2012/959260
19. De Vuono S, Ricci MA, Migliola EN, Monti MC, Morretta E, Boni M. Serum bile acid levels before and after sleeve gastrectomy and their correlation with obesity-related comorbidities. Obes Surg. 2019;29(8):2517-2526. doi: 10.1007/s11695-019-03877-6.
20. Duran İD, Gülçelik NE, Bulut B, Balcı Z, Berker D, Güler S. Differences in calcium metabolism and thyroid physiology after sleeve gastrectomy and Roux-en-Y gastric bypass, Obes. Surg. 2019;29(2):705–712. doi: 10.1007/s11695-018-3595-z.
21. Elmahdy TM, Elgarf S, Elshora A, Moussa G, Swelam A. Five-year outcomes of laparoscopic sleeve gastrectomy in the treatment of morbid obesity a retrospective analysis. Egypt J Surg. 2020;39:814-821 doi: 10.4103/ejs.ejs_83_20
22. GBD 2017. Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1923-1994. doi.org/10.1016/S0140-6736(18)32225-6
23. Ghosh SK, Roy S, Chekan E, Fegelman EJ. A Narrative of Intraoperative Staple Line Leaks and Bleeds During Bariatric Surgery, Obes. Surg. 2016;26(7):1601–1606. doi: 10.1007/s11695-016-2177-1.
24. Janssen F, Bardoutsos A, Vidra N. Obesity prevalence in the long-term future in 18 European countries and in the USA. Obes Facts. 2020;13(5):514–527. doi: 10.1159/000511023.
25. Koliaki C, Liatis S, Carel W, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17:50. doi: 10.1186/s12902-017-0202-6.
26. Kral TV, Roe LS, Rolls BJ. Does nutrition information about the energy density of meals affect food intake in normal-weight women? Appetite. 2002;39(2):137-45. doi: 10.1006/appe.2002.0498.
27. Kushner RF. Weight loss strategies for treatment of obesity. Prog Cardiovasc Dis 2014;56:465‑72. doi: 10.1016/j.pcad.2013.09.005.
28. Lee PC, Tan HC, Pasupathy S, Ganguly S, Eng AKH, Nadkarni N, Kwang Wei Tham KW. Effectiveness of bariatric surgery in diabetes prevention in high-risk Asian individuals. Singapore Med J. 2018; 59(9):472–475. doi: 10.11622/smedj.2018110
29. McTigue KM, Wellman R, Nauman E, Anau J, Coley RY, Odor A, Tice J, Coleman KJ, Courcoulas A, Pardee RE, Toh S, Janning CD, Williams N, Cook A, Sturtevant JL, Horgan C, David Arterburn D, PCORnet. Bariatric Study collaborative comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg. 2020;155(5):e200087. doi: 10.1001/jamasurg.2020.0087
30. Ministry of Health. World Health Survey Saudi Arabia (KSAWHS) 2019. https://www.moh.gov.sa/en/Ministry/Statistics/Population-Health-Indicators/Documents/World-Health-Survey-Saudi-Arabia.pdf. Accessed Oct 2022.
31. Navaneethan SD, Kelly KR, Sabbagh F, Schauer PR, Kirwan JP, Kashyap SR. Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery, Obes. Surg. 2010;20(3):308–315. doi: 10.1007/s11695-009-0026-1.
32. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel MT. Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Surg Obes Relat Dis. 2013;9(4):569-73. doi:10.1016/j.soard.2012.05.008.
33. Roe LS, Sanchez CE, Smethers AD, Keller KL, Rolls BJ. Portion size can be used strategically to increase intake of vegetables and fruits in young children over multiple days: a cluster-randomized crossover trial. Am J Clin Nutr. 2022;15(1):272-283. doi: 10.1093/ajcn/nqab321.
34. Saif T, Strain GW, Dakin G, Gagner M, Costa R, Pomp A. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg. Obes. Relat. Dis. 2012;8(5):542– 547. https://www.ncbi.nlm.nih.gov/pubmed/22398110.
35. Salem V, AlHusseini N, Abdul Razack HI, Naoum A, Sims OT, Alqahtani SA. Prevalence, risk factors, and interventions for obesity in Saudi Arabia: a systematic review. Obes Rev. 2022 doi: 10.1111/obr.13448.
36. Sarker A, Meek CL, Park A. Biochemical consequences of bariatric surgery for extreme clinical obesity. Ann Clin Biochem 2016;53(1):21-31. doi: 10.1177/0004563215588116.
37. Seki Y, Kasama K, Hashimoto K. Long‑term outcome of laparoscopic sleeve gastrectomy in morbidly obese Japanese patients. Obes Surg 2016;26:138‑45. doi.10.1007/s11695-015-1728-1
38. Sharma P, McCarty TR, Lange A, Ngu JN, Njei B. Impact of bariatric surgery on outcomes of patients with celiac disease: a Nationwide Inpatient Sample Analysis, 2004-2014. Ann.Gastroenterol. 2019;32(1):73–80. doi:10.20524/aog.2018.0323.
39. Sinclair P, Brennan DJ, le Roux CW. Gut adaptation after metabolic surgery and its influences on the brain, liver and cancer. Nat Rev. Gastroenterol. Hepatol. 2018;15(10):606-624. doi: 10.1038/s41575-018-0057-y.
40. Smethers AD, Rolls BJ. Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns. Med Clin North Am. 2018 Jan;102(1):107-124. doi: 10.1016/j.mcna.2017.08.009.
41. Van Rutte PWJ, Smulders JF, De Zoete JP, Nienhuijs SW. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg 2014;101:661‑8. doi: 10.1002/bjs.9447.
42. Vilahur G, Ben-Aicha S, Badimon L. New insights into the role of adipose tissue in thrombosis. Cardiovascular Research, 2017;113(9):1046–1054. doi.org/10.1093/cvr/cvx086
43. World Health Organization, Obesity and overweight. Geneva, Switzerland. Retrieved from https://www.who.int/newsroom/fact-sheets/detail/obesity-and-overweight. [Last Accessed 2018 Feb 16].
44. World Obesity Day. https://www.worldobesityday.org/. Accessed Oct 2022.
45. Woźniewska P, Diemieszczyk I, Hady HR. Complications associated with laparoscopic sleeve gastrectomy – a review. Prz Gastroenterol. 2021;16(1):5–9. doi: 10.5114/pg.2021.104733
46. Young MT, Gebhart A., Phelan M.J., Nguyen N.T. Use and outcomes of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass: analysis of the American College of Surgeons NSQIP. J. Am. Coll. Surg. 2015;220(5):880–885. doi: 10.1016/j.jamcollsurg.2015.01.059.