The History and Evolution of Bariatric Surgical Procedures
Section snippets
Jejunoileal Bypass
Given the fact that all nonsurgical attempts at weight reduction have involved limiting or reducing caloric intake, it is interesting that the first surgical attempts involved malabsorption, not restriction. Dr Viktor Henrikson4 of Sweden is credited with being the first to perform surgery for inducing weight loss and improving comorbidities. His 1952 article describes a case report in which he resected a 105-cm segment of small bowel in a 32-year-old woman suffering from obesity, constipation,
Biliopancreatic Diversion
Because of the morbidity associated with the defunctionalized limb in the jejunoileal procedures, Scopinaro and colleagues12 of Genoa, Italy developed the biliopancreatic diversion (BPD) procedure in the mid-1970s. The procedure involved a partial distal gastrectomy with closure of the duodenal stump. The jejunum was divided 250 cm proximal to the ileocecal valve. The distal limb (Roux limb) was then anastomosed to the proximal stomach. The proximal limb (biliopancreatic limb) was anastomosed
Gastroplasty
In search of a bariatric operation without the morbidity of intestinal or gastric bypass, several surgeons began developing gastroplasty procedures in the 1970s and 1980s. Gastroplasty procedures altered gastric anatomy to restrict caloric intake and induce early satiety, but avoided intestinal bypass and the associated long-term morbidity. The first attempts by Printen and Mason27 were performed in 1971. This procedure consisted of horizontal division of the upper stomach, creating a small
Laparoscopy in Bariatric Surgery
The introduction, development, and refinement of laparoscopic techniques have been the biggest contributor to the increase in the number of bariatric procedures performed in the last decade. The associated shorter length of stay, quicker recovery, less pain, and large reduction in wound-related problems such as infections and incisional hernias, with similar results in other outcomes, has led to increased patient demand.66
The first laparoscopic procedures for obesity were performed in the early
Summary
The search for the ideal weight loss operation began more than 50 years ago when obesity was rare, but its detrimental health effects were coming to light. Surgical pioneers, recognizing the growing need to help these patients, developed innovative, but unproven procedures that initially created malabsorption, then restricted volume intake, and eventually combined both techniques. Variations, alterations, and modifications of these original procedures, combined with intense efforts to follow
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