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A number of candidates of bariatric surgery may have a concomitant ventral hernia. Simultaneous repair of ventral hernia with bariatric surgery remains a subject of controversy in surgical practice. We present a morbid obese patient who underwent single anastomosis sleeve ileal (SASI) bypass while having a ventral hernia. The procedure for the repair of hernia was postponed until after the bariatric surgery was done. The untreated ventral hernia caused bowel incarceration and anastomosis leakage during the postoperative days. So it seems that patients with small size ventral hernia with no intestinal or omental adhesions may benefit from hernia repair at the same time with bariatric surgery, however, in patients with large or complex ventral  hernia and severe bowel  and omental adhesions, it is advisable not to release adhesions and that the hernia repair be carried out  after the patients weight loss is achieved, to prevent iatrogenic bowel injury and minimize the risk of hernia recurrence  and incarceration.

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Abstract Background and aims: Obesity is one of the challenging public health issues which can increase the risk of different morbidities like respiratory disorders. Some studies suggested that significant weight loss may be associated with the improvement of pulmonary function in morbid obese patients. Bariatric surgeries are the most effective was for significant weight loss in morbid obese patient. The aim of this study was to determine the effects of bariatric surgery on the pulmonary function in the morbid obese patients. Materials and methods: This prospective, before-after study was conducted on morbid obese patients who underwent bariatric surgery in Loghman Hakim hospital during 2019. All morbid obese patient (BMI ≥ 40) who presented to the hospital in the study period were included in the study by convenience sampling. Patient’s demographics and results of spirometry test variables were recorded in a questionnaire before the surgery and three months after the surgery. SPSS software version 25 was used for data analysis. Results: Thirty-eight patients were entered in the final analysis. The mean age of patients was 39.2 ± 11.6 (range:15-65). Fifteen patients in this study were male (39.5%). There were significant relations in the values of BMI, FEV1, FEV1/FVC before and after the surgery. In addition, there were significant negative correlation between FEV1 and BMI. Furthermore, functional dyspnea and obstructive sleep apnea were seen in 50% and 21% of patients which completely improved after the study. Conclusion: Bariatric surgery has significant effects on the improvement of pulmonary function in morbid obese patients.

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Background: According to the IFSO worldwide survey report in 2014, 579517 bariatric operations have been performed in a year, of which nearly half the procedures were SG followed by RYGB. This procedure is a proven successful treatment of patients with morbid obesity which induces considerable weight loss and improvement of type 2 diabetes mellitus, insulin resistance, inflammation, and vascular function. In the present study, we aimed to build a machine based on a decision tree to mimics the surgeons pathway to select the type of bariatric surgery for patients.
Material and methods: We used patient’s data from the National Bariatric Surgery registry between March 2009 and October 2020. A decision tree was constructed to predict the type of surgery. The validation of the decision tree confirmed using 4-folds cross-validation.
Results: We rich a decision tree with a depth of 5 that is able to classify 77% of patients into correct surgery groups. In addition, using this model we are able to predict 99% of bypass cases (Sensitivity) correctly. The waist circumference less than 126 cm and BMI equal to or more than 43 kg/m2, age equal to or greater than 30 years old, and being hypertensive or diabetes are the most important separators.
Discussion: The effects of all nodes have been studied before and the references confirmed the relations of them and surgery type.