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INTRODUCTION
The world epidemic of overweight is estimated to include about
1.7 billion individuals (Buchwald et al, 2004).
Morbid obesity is associated with serious comorbid conditions,
including hypertension type 2 diabetes mellitus, dyslipidemia,
osteoarthritis, and gallbladder disease. Bariatric surgery

has been

demonstrated to be an effective weight-loss alternative for the morbidly

obese

and is associated with marked resolution of

comorbidities

(Cremieux et al, 2008).

There are about 72 million adults suffering from obesity in the
US. Only 1% of the clinically eligible population is being treated for
morbid obesity through bariatric surgery (CDCP, 2009).
In Egypt 30.3% of the adult population are considered obese
according to the latest figures. The highest percentage of any country in
the Mediterranean region and the 4th in the middle east only preceded
by Saudi Arabia, Kuwait and the United Arab Emirates (El-Zanaty , Way
, 2009).
Some patient may refrain from bariatric surgery because of the
risks associated with current procedures and their high costs
.Traditionally, the primary mechanisms thr ough which bariatric
surgery achieves its outcomes are believed to be the mechanical
restriction of food intake, reduction in the absorption of ingested foods,
or a combination of both (NIH, 1992).
Laparoscopic adjustable gastric banding (LAGB) and vertical sleeve

Introductionand
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gastrectomy (VSG) are restrictive approaches commonly used in

bariatric practice (Martin et al., 2007), although these procedures have
proven to be good therapeutic options for some patients, they are not
without significant complications, such as erosion or slippage of the
gastric band or gastric leaks in VSG (Nocca et al., 2005).
Leaks in VSG pose a particular difficult challenge when they occur
near the angle of Hiss, potentially generating severe clinical
conditions that require reoperation and may even cause death
(Baltasar et al., 2007).
An alternative procedure that can be as restrictive as
sleeve gastrectomy is laparoscopic gastric plication (LGP), a restrictive
bariatric surgical technique that has the potential to eliminate the
complications associated with LAGB and VSG by creating restriction
without the use of an implant and without gastric resection and stapling
and at a much lower cost (Ramos et al, 2010).
LGP is an emerging procedure that requires additional studies
to assess long-term efficacy. Initial studies suggest that LGP may
provide effective surgical weight loss with a potentially lower risk
profile than other bariatric procedures (ASMBS, 2009).

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AIM OF THE WORK

The purpose of this study is to assess the outcomes of vertical
gastric plication in comparison with sleeve gastrectomy, which is a
standard bariatric procedure, these outcomes include efficacy of weight
reduction, effects on obesity co-morbidities, Safety and cost.