Go Back in Time
You’re considering having bariatric surgery. At first, you were just thinking about your own body, which procedure(s) would help you lose weight fast, and how you would pay for it. But as you dig in, you might get interested in how bariatric surgery got started and how it’s changed over time. Why not take a few minutes to learn a little history? You might teach your friends something — and maybe even your surgeon!
How Bariatric Surgery Got Started
Bariatric surgery has been getting more and more popular lately, with some modern celebrities publicly revealing their choice to have bariatric surgery. Because of this, many people believe that bariatric surgery is a very new invention. So you might be surprised to learn that the first bariatric surgery was performed in the 1950s.
The First Bariatric Surgery: Jejunoileal Bypass
At that time, surgeons performed a procedure called jejunoileal bypass. The procedure simply bypassed the first part of the small intestine by connecting a lower part of the small intestine directly to the stomach, without reconnecting the upper small intestine as is currently done in gastric bypass and duodenal switch procedures. The bypassed part of the small intestine was closed on both ends and not connected at all. Though the procedure was effective at inducing weight loss, it caused many complications, including vitamin and mineral deficiencies and lack of protein (because it couldn’t be digested without the pancreatic enzymes). Additionally, because the bypassed part of the small intestine was completely closed off, bacteria could overgrow within that space, and caused severe infections in some people. Quite a few patients who’d had this procedure became severely ill, and many required a reversal of the procedure.
Surgeons could have given up on bariatric surgery, deciding that it was too dangerous. But a few of them saw the potential in the approach, and began to work on modifying it to be safer.
Gastric Bypass Invention
In the 1960s, two surgeons noticed that when people underwent partial removal of the stomach for peptic ulcers, they often experienced weight loss afterwards. This got the surgeons thinking about using partial removal of the stomach for bariatric surgery. They combined this with the success of the jejunoileal bypass procedure, but modified it so that the bypassed part of the small intestine was connected into the main tract later, allowing pancreatic enzymes and bile to mix with the food and preventing the dangerous trapping of bacteria. Putting all of these ideas together, they created the gastric bypass. After some years of using this operation, it was somewhat modified into the current gastric bypass procedure, known as a Roux-en-Y Gastric Bypass (RYGB). This is still the most common bariatric surgery performed.
Restrictive Procedures: Stomach Stapling
Other doctors tried variations on purely restrictive procedures. Very early physicians had experimented with weight loss surgery by wiring the jaw nearly shut so that eating would be difficult. Not surprisingly, few patients were interested.
In the 1970s, a procedure called gastroplasty began to be used. It relied on the surgical stapler, a newly invented device. The stapler was used on the stomach, to staple it into two compartments: a small upper one and a large lower one. This procedure was also called “stomach stapling.” It was not very effective, and after several years of trying different variations of it, it was abandoned.
The next variation, in 1980, involved placing a mesh ring around the upper part of the stomach. The mesh was replaced by different materials until silicone was finally used in 1983. The silicone banding of the stomach is still used, although it’s been modified so that the band is adjustable.
The newer gastric bypass procedure produced good results, and with long-term follow-up and nutritional supplementation, many complications could be avoided. However, many patients were developing complications from the large abdominal incisions required to perform the procedure. As many as 8% were developing wound infections in the incisions, and 20% were developing hernias in the incisions (sometimes years later).
To solve this problem, doctors realized they could use a laparoscopic technique. This would allow very small incisions to be made, which would reduce all of the above complications. The success of this approach was first reported in 1994. The laparoscopic gastric bypass is technically very challenging, so it needs to be done by a surgeon who is specifically trained in this technique; it’s also not possible in every patient. But it leads to similar outcomes with regard to weight loss and hormonal changes, without the incisional complications.
Today, You Have Many Options
Surgeons have spent decades developing bariatric surgery, creating newer and better procedures using techniques from other areas of surgery. Today, you have a variety of options if you’re very overweight and want to lose weight fast. Bariatric surgery is medically proven to result in weight loss that lasts in a majority of people. So if you’re frustrated because you’re trying to lose weight and nothing is working, learn about your bariatric surgical options!