A few decades ago only the rich and famous tended to go through what the weight loss industry called stomach stapling. It was something not widely talked about; almost shameful someone would need to resort to such a procedure. In the recent years bariatric surgery has become much more prevalent and is even covered by many insurance companies as a means to prevent other health issues.
Early Bariatric Surgery Option
The first attempts at bariatric surgery were performed in the early 1950s. It was in 954 when the first surgery was submitted to a peer-reviewed journal. It was performed by Dr. A.J. Kremen and was called the jejunoileal bypass or as he called it, an intestinal bypass. This involved bypassing the middle section of the intestines and connecting the top and bottom sections. The object was to reduce the absorption of food and it did work but had numerous side effects that negatively impacted the health of the patient. The morality rate was 50%. Around the same time, a Swedish physician was performing a similar surgery, but he removed the bypassed intestinal section.
During the 1950s and into the 1960s doctors continued to experiment on different operations to help morbidly obese patients lose weight. All of the early surgeries involved bypassing or removing sections of the intestine. It wasn’t until the mid-1960s gastric bypass surgery was introduced. Though not specifically called gastric bypass in the beginning, the surgery involved reducing the stomach size as a component of the procedure.
Early Gastric Bypass Surgery
Dr. Edward E. Mason of the University of Iowa began developing gastric bypass surgery in 1966. At the time it was known as intestinal bypass or sometimes, stomach stapling. The surgery involved isolating a portion of the upper stomach with staples to decrease the amount of food the stomach could hold. Over the next years the surgery was experimented with and refined. Metal staples gave way to elastic bands, but those were found to stretch over time and so currently are seldom used.
In the late 1970s in Genoa Italy, Dr. Nicola Scorpinaro developed the billiopancreatic diversion. This type of surgery involved removing portions of the stomach and connecting the remaining portion to the small intestine. This led to the development of the Duodenal Switch by Douglass Hess in 1989; and eventually to the LapBand and the Roux-en-Y bypass surgery, the most commonly performed surgery today.
Common Current Bariatric Surgery Options
Bariatric surgery can be placed in one of three categories: malabsorption, restriction, or a combination of both. The early surgeries, jujunoileal bypass and billiopancreatic diversion are malabsorptive and are rarely used due to the risk and side effects. Today, there are numerous options for obese patients.
- Roux-en-Y: This is the most commonly used procedure for gastric bypass. It includes both restriction and malabsorption components. The procedure reduces the stomach by isolating a thumb-size portion of the upper stomach by stapling it off from the lower portion. The upper portion is then attached to the small intestine, bypassing the duodenum and other segments of the small intestine to cause malabsorption. The lower portion of the stomach is no longer used, but is left in the body.
- Gastric banding: this procedure is considered a reversible procedure and is the second most common procedure performed today. A flexible, adjustable band is put around the upper portion of the stomach. A port is placed in the abdomen and connected to the band to allow the doctor to fill or remove saline from the band. This adjustment increases or reduces the size of the stomach opening to allow more or less food. This procedure is often called Lap-Band.
- Vertical Banded Gastroplasty (VBG): During the surgery procedure a circular “window” is made in the upper portion of the stomach. A small vertical pouch is created by a row of staples from the window up towards the esophagus. A small opening at the bottom of the pouch allows food to go into the lower portion of the stomach and pass through the digestive system. A band made of polypropylene is placed through the window around the small opening at the bottom of the pouch and secured with stitches. The band controls the size of the opening and prevents it from stretching, thus controlling the feeling of “fullness.”
- Gastric Sleeve Surgery: During this procedure the surgeon removes about 60-80% of the stomach. A small tube is left which creates a new stomach the starts at the natural stomach opening and ends at the natural stomach outlet.
- Distal gastric bypass: This is also called the duodenal switch. As previously stated, this surgery requires the removal of a portion of the stomach. It is considered a high risk surgery and is generally only used in extreme cases.
Over the last decade the problems of obesity have become more prevalent and in response, insurance companies have been less reluctant to include bariatric surgery as a solution to health issues. Though not a solution for everyone, gastric bypass surgery is an option for many obese patients and has produced positive results. Anyone considering this option should discuss the risks and side effects, both physical and emotional, with their doctor and research all options available to make an informed decision.
- Weight Loss Surgery Cost. (2009). History of weight loss surgery. Retrieved from http://www.weightlosssurgerycost.com/general/history-of-weight-loss-surgery.htm
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