Naturally Banded Versus Synthetic Banding of Sleeve Gastrectomy

to compare banding sleeve gastrectomy using silicone ring Versus using natural flap ( round ligament of the liver) as regard weight loss, complications rat and cost

• natural band (Procedure): to use the round ligament as a natural band in stead of synesthetic band with sleeve gastrectomy
• silicone band (Procedure): to use synesthetic band with sleeve gastrectomy

Primary outcomes

• total cost [12 hours]: total operative cost in Egyptian pound (LE)
• food intolerance [1 year]: food intolerance at one year food tolerance arabic score questionnaire

Secondary outcomes

• %EWL [1 year]: percentage of weight loss at one year measured as (initial weight - follow-up weight) / (initial weight - bodyweight at a BMI of 25 kg/ m2) x 100
• complications rate [1 year]: the incidence of early and late complications according to Clavien-Dindo (CD)
• improvement of comorbidities [1 year]: the incidence of improvement of comorbidities

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* obese patients with BMI more than 40 with or without co-morbidity or more than 35 with co-morbidity
* patients fit for laparoscopic surgery
* give approval to share in the study

Exclusion Criteria:

* patients refused to share in the study
* patients unfit for surgery
* patients aged less than 18 and older than 65
* patient with previous upper abdominal surgery either for obesity or other diseases
* revisional bariatric procedures