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IN THE NAME OF GOD

IN THE NAME OF GOD. Dr Mohammad Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science. THE ROLE OF BARIATRIC SURGERY IN INFERTILITY AND PERIODIC CYCLE. Disease Incidence Gynecologic comorbidity : Infertility Periodic cycle Sexual activity

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. Dr Mohammad Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science THE ROLE OF BARIATRIC SURGERY IN INFERTILITY AND PERIODIC CYCLE

  3. Disease • Incidence • Gynecologic comorbidity: Infertility Periodic cycle Sexual activity • Surgery: Restrictive (TVGP) Malabsorptive (GB, very rare in female) • Aim: Assessment the role of bariatric surgery in gynecologic comorbidity MORBID OBESITY

  4. Patient selection: (2002 to 2008): BMI>40 BMI>35 with co morbidity like diabetes and so on) • Patient subdivision: Postmenopouse(A) Premenopouse married (B) Premenopouse virgin (C) • Technique of choice: Morbid obesity: Total gastric vertical plication (TGVP) Super obesity: TGVP or Gastric Bypass • Changes of infertility or irregularity of periodic cycle recorded at least during first year of operation. MATERIAL & METHOD

  5. Laparoscopic • Conservative • Low price • Reversible • Volume residue: 50 cc • EWL: 60% during 6 month • Unrelated to technique morbidity: 2% • Reoperation: 2% • High cooperation in female • Safe alternative between restrictive operations ADVANTAGES OF TVGP

  6. Invasiveness of methods

  7. Supine position • Trocars: 10 mm (one), 5 mm (three) • Ergonomy • Greater curvature release by ligature • Angle of Hiss preserve • Plication at greater curvature by continuous suture 00 nylon • From cardia to 5 cm of pylorus METHOD OF TGVP

  8. False positive sense of thirsty • Effective volume of stomach: 50 cc • Pain or reflux secondary to more intake: Inhibitory effect • Gradually dilation of remnant volume (4 years) 50 cc to 200 cc • Psychological control to continue diet RESULT OF METHOD

  9. RESULT 300 cases during 6 years 254 female (mean age of 30 years old and mean BMI of 43) Follow up of 47 cases was impossible (29 female) Mean excessive weight loss : 1 month 20% EWL 6 months 60% EWL 12 months 75% EWL In 220 cases technique of choice was TGVP and in remaining it was bypass (5 cases).

  10. RESTRICTIVE: EARLY MORBID OBESITY WITH COOPERATION (262 TVGP), 249 FEMALE: 220 WITH FOLLOW UP • MIXED: LATE MORBID OBESITY WITH COOPERATION (24 GB), 4 FEMALE OMEGA ANASTHOMOSIS CONTINOUS HAND SWEN NYLON 00 • MALABSORPTIVE: MORBID OBESITY WITHOUT COOPERATION (14 ILEOJEJUNAL BYPASS), 1 FEMALE TECHNIQUE SELECTION

  11. group A: 21 (mean age 52 years, mean BMI 45) • group B: 69 (mean age 34 years, mean BMI 44) 30cases (43%) complained of irregular cycle 14 cases (20%) were infertile (>6 months failure) • group C: 135 (mean age 25, mean BMI 42) 57 cases of group C (42%) complained of irregular cycle. result

  12. Infertility: 10cases of infertile group got pregnant (71%) after one year of operation • Periodic cycle: In 24 cases of group B (80%) and 46 cases of group C (81%) periodic cycle got regular at the end of one year (after one month the first case got regular) • PCO: 27 cases of this group were known cases of polycystic ovary (PCO) and in 16 of them regular cycle after operation recorded RESULT

  13. RESULTS

  14. Rate of infertility (20%) and irregular cycle (42%) in morbid obese female is higher than general population • The main option for treatment of this problem is weight loss with good response (71% and 81%) • After one year of weight loss other options of treatment is advised. CONCLUSION

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