Introduction: Morbid Obesity affects as much as 10% of the American population. The morbidly obese are subject to social stigma & to increased risk of sudden death due to heart attack, stroke & several concomitant health problems. Bariatric procedures are used to treat Morbid Obesity. Sleeve gastrectomy is one of the restrictive bariatric procedures. It includes resection of the fundus and body of stomach to create a long, tubular conduit along the lesser curve (leaving 20–30% of the stomach). Open or laparoscopic approach, can be used. The mechanisms of weight loss and improvement in comorbidities seen after Sleeve gastrectomy might be related to gastric restriction, Neuro-Humoral changes, or some other unidentified factors. Sleeve gastrectomy is not free of problems, It needs a team work, a careful patient preparation & investigation to avoid early & late post operative complications. The Aim of this study is to present our early experience in Sleeve gastrectomy. Material and Methods: 35 patients were selected, 32 females & 3 males, the age range was between 17–49 year. Their weight were between 105˘ 1.7 cm) was significantly smaller than that of non-pCR (4.7 ± 2.1 cm). The mean Ki67 index in pCR and non-pCR were 29.6 ± 16.9% and 21.3 ± 16.5%, respectively. Negative ER, negative PgR, positive HER2 status and a higher Ki67 were found to be significantly predictive of a pCR. For NAC regimen, 63 patients received either anthracycline or taxane based regimen (A or T), and 257 patients received both of them (A + T). 18 patients were received concurrent trastuzumab with taxane. 51 (20%) of the patients treated with A + T regimen achieved pCR, while only 5 (8%) of the patients treated with A or T regimen. A significant difference between them was observed. In multivariate analysis, the probability of pCR was directly associated with tumor size [OR for one cm increase, 0.706, 95% confidence interval (CI), 0.564–0.883], Ki-67 index [OR for 10% increase in the percentage of positive cells, 1.023, CI, 1.002– 1.044], ER [OR for negative 0.148, CI 0.042–0.522], HER2 [OR for positive 0.461, CI 0.213–0.999] and use of trastuzumab [OR for use 0.074, CI 0.018–0.306]. Results: An average of 10 kg loss per month were noted & a marked improvement in weight related co-morbidities (DM, Hypertension, Sleep Apnea, Dyslipidemia) were reported. Wound infection, B12 & Iron deficiency, Hair fall, Vomiting, Port Hernia & GERD were the post operative complication. One patient needed a redo operation (bypass procedure). One patient died because of Guillain-Barre´ syndrome (not related to the procedure). Conclusions: Sleeve gastrectomy as first step or the only step in treating morbid obesity is a safe procedure, with accepted weight loss, yet it is not with out side effect
Introduction: Morbid Obesity affects as much as 10% of the American population. The morbidly obese are subject to social stigma & to increased risk of sudden death due to heart attack, stroke & several concomitant health problems. Bariatric procedures are used to treat Morbid Obesity. Sleeve gastrectomy is one of the restrictive bariatric procedures. It includes resection of the fundus and body of stomach to create a long, tubular conduit along the lesser curve (leaving 20–30% of the stomach). Open or laparoscopic approach, can be used. The mechanisms of weight loss and improvement in comorbidities seen after Sleeve gastrectomy might be related to gastric restriction, Neuro-Humoral changes, or some other unidentified factors. Sleeve gastrectomy is not free of problems, It needs a team work, a careful patient preparation & investigation to avoid early & late post operative complications. The Aim of this study is to present our early experience in Sleeve gastrectomy. Material and Methods: 35 patients were selected, 32 females & 3 males, the age range was between 17–49 year. Their weight were between 105˘ 1.7 cm) was significantly smaller than that of non-pCR (4.7 ± 2.1 cm). The mean Ki67 index in pCR and non-pCR were 29.6 ± 16.9% and 21.3 ± 16.5%, respectively. Negative ER, negative PgR, positive HER2 status and a higher Ki67 were found to be significantly predictive of a pCR. For NAC regimen, 63 patients received either anthracycline or taxane based regimen (A or T), and 257 patients received both of them (A + T). 18 patients were received concurrent trastuzumab with taxane. 51 (20%) of the patients treated with A + T regimen achieved pCR, while only 5 (8%) of the patients treated with A or T regimen. A significant difference between them was observed. In multivariate analysis, the probability of pCR was directly associated with tumor size [OR for one cm increase, 0.706, 95% confidence interval (CI), 0.564–0.883], Ki-67 index [OR for 10% increase in the percentage of positive cells, 1.023, CI, 1.002– 1.044], ER [OR for negative 0.148, CI 0.042–0.522], HER2 [OR for positive 0.461, CI 0.213–0.999] and use of trastuzumab [OR for use 0.074, CI 0.018–0.306]. Results: An average of 10 kg loss per month were noted & a marked improvement in weight related co-morbidities (DM, Hypertension, Sleep Apnea, Dyslipidemia) were reported. Wound infection, B12 & Iron deficiency, Hair fall, Vomiting, Port Hernia & GERD were the post operative complication. One patient needed a redo operation (bypass procedure). One patient died because of Guillain-Barre´ syndrome (not related to the procedure). Conclusions: Sleeve gastrectomy as first step or the only step in treating morbid obesity is a safe procedure, with accepted weight loss, yet it is not with out side effect