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Non-alcoholic fatty liver disease (NAFLDs) is a health hazards and emerging threat in the recent three decades (1). NAFLD is frequently associated with obesity, diabetes mellitus and the metabolic syndrome. However, nowadays, its prevalence has grown to 30% among general population with the growing pattern in developing countries (2, 3). Liver cirrhosis and hepatocellular carcinoma (HCC) are the main causes of liver-related morbidity and mortality in the communities (4). Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major worldwide risk factors for chronic liver disease, (5, 6, 7). There are emerging evidence regarding contribution of diabetes, obesity, intake of high fat foods and metabolic syndrome to higher incidence of HCC in the world (8). Changing the life style and modification of obesity can help us for the best achievements to prevent these consequences of the liver disease (9). Unfortunately, changing the life style is not always possible and most of the drugs are ineffective to control obesity and fatty liver (10), however, weight loss is mandatory for stopping the natural history of NAFLDs (1). Obesity is also associated with hypertension, insulin resistance, diabetes type II, hyperlipidemia and ischemic heart disease (8). The epidemy of obesity in Iran and the world is a major public health issue. More than one fourth of adults are obese and more than 3% are morbid obese in Iran (11). High prevalence of fatty liver among the patients undergoing bariatric surgery has increased the interest in foregut bariatric surgery as a potential treatment for NAFLDs. Surgery for morbid obesity, bariatric surgery, is the most durable treatment for this disease (12). For the first time, surgical approach for stomach cancer showed the significant weight loss after surgery and the researchers noticed the importance of these types of surgery for morbid obesity (12). Roux-en-Y gastric bypass surgery for morbidly obese in type II diabetic subjects is associated with malabsorption co-morbidity, so recently; it has been replaced by the laparoscopic sleeve gastrectomy (LSG). LSG, creating a narrow tube-like stomach, is a restrictive procedure designed to decrease appetite by reducing the ability of the stomach to distend and producing the sensation of fullness with minimal oral intake (2, 11, 13). LSG has been shown in initial studies to produce excellent excess weight loss comparable with laparoscopic Roux-en-Y gastric bypass in many series with a very low incidence of major complications and death (2, 12). LSG is not technically as difficult as laparoscopic Roux-en-Y gastric bypass and it has a restrictive malabsorptive approach. Moreover, this type of surgery with minimum nutritional concern leads to a significant weight loss (3, 11). It seems that LSG is a definitive weight loss surgery for some patients and it can reverse the comorbidities. However, this type of surgery has some early or delayed disadvantages with potential complications especially if is done by non-expert surgeons. Several methods are available in the bariatric algorithm, however; LSG has been gaining traction as an effective mean for weight loss in patients with morbid obesity (12, 14, 15, 16).

The impact of foregut bariatric surgical procedure on natural history of liver histology among severe obese patients is not clear enough. Unfortunately, there are not any randomized clinical trials to evaluate different types of foregut bariatric surgical procedure in treatment of NAFLDs and most of studies are retrospective or prospective cohorts (10). Increase in lipid profile and insulin resistance after significant weight loss reported following foregut bariatric surgery (13). Significant increase in the prevalence and severity of liver steatosis and ballooning has also been reported one and five years, following different types of bariatric surgery (17) such as gastric band, biliary intestinal bypass and gastric bypass. A meta-analysis published in 2008, showed the beneficial effects of bariatric surgery on the liver histology among patients with NAFLDs (18) in which steatosis, steatohepatitis, and fibrosis appear to be improved or completely resolved after bariatric surgery. However, we should not forget the lack of RCTs for assessments of befits and harms of bariatric surgery as a therapeutic approach for patients with NAFLDs (19). Finally, the role of bariatric surgery in patients with established cirrhosis due to NAFLDs is not clear until now.

In conclusion, I would like to emphasize on the importance of LSG, not only as an established and alternative therapy to the other ones in NAFLDs, but also as a complementary for the puzzle of weight loss in morbid obesity in Iran, considering that patients follow up after surgery by a team consists of nutritionists, hepatologists and psychiatrics could be useful to prevent the relapse.

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Background

In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985). Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery.

Objectives

This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up.

Materials and Methods

Participants were selected regarding the U.S. National Institute of Health (NIH) guidelines, which indicates BMI > 40 kg/m² alone, or BMI > 35 kg/m² in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%). The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year.

Results

Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001), while no significant difference was found in which the parameters between two studied procedures were in this regard.

Conclusions

To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

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The second international congress of bariatric and metabolic surgery was held by Iranian society of bariatric surgery and minimally invasive surgery research center, Iran University of Medical Sciences on December 16-18 2015 (1).

This congress was held for the first time and it was performed simultaneously with the fifth national congress of prevention and treatment of obesity in Iran. It was done as “Iran’s first obesity week” by Iran obesity society and research institute for endocrine sciences in Milad hospital with the aim to increase interdisciplinary cooperation and have a comprehensive approach to obesity treatment and prevention.

This congress aimed to present the latest medical achievements of bariatric and metabolic surgeries in world and also to present the latest related outcomes and articles in Iran and the whole world. Topics of the congress included: different types of metabolic and bariatric surgeries, children and teenagers bariatric surgery, necessary procedures before and after bariatric surgery such as nutrition, psychology, psychiatry, periodic testing and related consultations, bariatric surgery and lifestyle changes, medical treatment team of bariatric surgery, bariatric surgery and treatment of comorbidities and the latest surgical techniques of diabetes surgery.

More than 50 prominent professors in the field of obesity and metabolic surgery including Professor Miller, Chevallier, Ugale, Ghavami, Pazouki, Khalaj, Talebpour and other visiting professors presented their latest achievements as oral presentation and poster. In this congress several live surgeries including gastric bypass surgery, sleeve gastrectomy, mini gastric bypass, Ileal interposition, gastric plication and revision were done. Two debates also were performed in this congress with two cases that professors discussed about their suggested surgery method (gastric banding, gastric bypass, sleeve gastrectomy and gastric plication) for the patients and their reasons for either selecting or refusing a specific method that of course it was paid attention by lots of participants. Also a part of congress was allocated to introducing the National obesity surgery database (2) that is approved by ministry of health and medical education of Iran that was welcomed by foreign surgeons and it was assigned to be presented in next IFSO congress.

The conductor of the congress was the obesity and metabolic surgery association which was the subset of Iran laparoscopic association with the cooperation of minimally invasive surgery research center, Iran University of Medical Sciences. The congress sponsors were Ethicon, Storz, Persiamehr, Medtronik and other dependent companies and the congress executive coordinator was HamayeshSazan group.

Finally, a common statement was made by Iran obesity society and research institute for endocrine sciences considering all aspects of obesity treatment and prevention with a greater emphasis on children and teens. In that statement, with taking a look at campaign against childhood obesity problem that is started with WHO secretary general’s slogan of “ending childhood obesity”, Iran obesity society and Iran laparoscopic association do emphasis on doing and planning below points:

1) Paying attention to each person’s health; 2) formulation of a national document based on research results and in line with Iran’s social and cultural conditions; 3) comprehensive obesity treatment and prevention with emphasis on public education and particularly efforts to create a suitable nutritional environment in schools; 4) extra attempt to emendate lifestyle during pregnancy and first years of life, 5) a compulsion existence to enter a topic entitled obesity treatment and prevention in different categories of student textbooks and also inclusion of this topic in curricula of medical schools and offering relevant MPH courses; 6) participation of different groups especially dietitians, physical activity professionals and clinical and health psychologist in treatment of obesity and if necessary, the use of effective interventions such as bariatric surgeries in severe obese group of children will be so effective; 7) cohesion and interaction between all organizations and institutions related to kids’ obesity prevention and treatment program by the ministry of health and medical education as the custodian of health system.

In similar way and according to the schedule and with the aim to continue to provide the latest scientific achievements in the field of laparoscopic surgery and procedures in their related specialties such as general surgery, ear, nose and throat, neurosurgery, gynecology and midwifery, orthopedics, radiology and so on, the MIS international congress of laparoscopy also will be held on November 8-10 2016.

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Background: The aim of this study was to evaluate the prevalence of H.pylori, before and one year after Roux-en Y gastric bypass surgery.
Method: The laparoscopic research center database from 2018 to 2020 was queried to identify patients undergoing laparoscopic Roux-en Y gastric bypass surgery(LRYGB). Retrospectively, the patients were evaluated for the presence of H.pylori infection via endoscopy or H. pylori Stool Ag before and 1 year after the surgery.
Results: Among the 106 patients, H.pylori was positive in 50 (47.2%) patients pre-operatively. Based on post-op evaluation among 54 patients, only 4 (7.4%) developed post-op H.pylori infection.
Conclusion:. eradicating H. pylori in patients under Roux-en Y gastric bypass surgery remains efficient. So, it is not recommended to re-checked H.pylori Ag in patients after Roux-en Y gastric bypass surgery in the short term; but, further studies are suggested to evaluate the need for re-screening patients for H.pylori Ag in the long term after Roux-en Y gastric bypass surgery
Keywords: Helicobacter Pylori; Iran;LRYGB;

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The prevalence of body image dissatisfaction is considered high in both developed and developing countries. Studies on obese individuals have shown associations between the risks of obesity and its hazardous effects both on physical and mental health as well as on the body image. Development of body image dissatisfaction in Eastern communities has been increased in the past years. Despite many studies in Asian societies, In Iran, studies are scattered and limited. Preventing and alleviating body Image dissatisfaction among Iranian obese women is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target body Image dissatisfaction in Iranian obese women. Quantitative outcome studies between March 2016 and February 2021 in English and Persian language were included. Articles were identified by searching electronic databases, journals and abstracts, and contacting key informants. Information was extracted and synthesized using a standard form. 9 studies were identified. their design, methods, quality and transferability varied considerably. Just 1 of the 10 effective interventions were group activities. The review suggests that all of interventions are effective, involving some form of mindfulness and emotion regulation training that targeted obese women.