Bariatric Surgery has evolved as a treatment for the management of obesity. It has become an accepted alternative to weight-loss diets, because of the numerous benefits that such a treatment provides. As a result, a large number of people are undergoing bariatric surgery. It allows people to lose weight rapidly and as a consequence, start to enjoy the benefits of a healthier lifestyle in no time. Nowadays, bariatric surgery has been combined with standard laparoscopic techniques, allowing the procedures to become minimally invasive.
New surgical techniques and specialized surgical instruments have also been introduced into this surgical modality. Because of these new advances Bariatric Surgery has become a much safer and more effective therapeutic measure for loosing weight.
Bariatric surgery can be traced back to the 1950’s. The first bariatric surgery was performed in 1954 by Dr. A.J. Kremen. The procedure was an intestinal by-pass. Dr. Kremen joined the distal and proximal portions of the small intestine together so that food would “bypass” the middle portion of the intestine. This in effect, created a malabsorption syndrome. About the same time in Sweden, a similar procedure was developed, but in this procedure, in contrast to Dr. Kremen’s original surgery, the redundant portion of the small intestine was removed.
Regrettably, patients on whom these surgeries were performed developed a number of complications, such as dehydration, diarrhea, metabolic disturbances and electrolyte imbalances, among others. Because of these complications, the intestinal by-pass surgeries were abandoned making way for other surgical alternatives.
Gastric bypass surgery was developed in 1966, by Dr. Edward E. Mason of the University of Iowa. In this technique, surgical staples were used to make a compartment in the upper portion of the stomach creating a limitation on the amount of food ingested. This produces a sensation of fullness (satiety) with little intake of food. If you eat less, you eventually lose weight. The procedure was called vertical banded gastroplasty.
Different techniques soon evolved to improve the gastric pouch remnant, making it a popular surgical treatment. However, with time patients began to notice a gradual increase in their weight. This was due to the lifespan and complications of the different materials used to create the gastric pouch reservoir such as mesh, rings, surgical tapes and fixed bands. These stretched or migrated allowing the patients to eat large amounts of food again and regain their weight.
Subsequently, with the advent of the Roux-en-Y By-pass procedure, Bariatric Surgery gained the popularity that it enjoys at the present time. The surgeon, in this procedure creates a very small pouch in the stomach by stapling the upper-most portion of the stomach and attaches it to a pre-determined segment of the small intestine; this creates the Gastric By-pass. The gastric pouch is very small and its measured volume may vary from 15ml to 30ml. This causes a restriction of volume intake, diminishes the amount of ingested food and accelerates the digestive process. These conditions contribute to create a malabsorption syndrome.
There are many different procedures that have evolved since the original Gastric By-pass giving the obese patient options to discuss at length with his Bariatric Surgeon. These include: the Intra-Gastric balloon, the Adjustable Gastric Band, the Gastric Sleeve, Duodenal Switch, the Mini By-pass procedure, the Fobi Pouch and the development of Minimally Invasive Laparoscopic technology among others. As an evolving surgical field that stands to improve the obesity disease, Bariatric Surgery will be an integral part for its treatment.