There is perhaps no other single medical procedure that can have such a profound effect on a person, their physical wellbeing, their self-esteem and their overall future prospects as bariatric weight loss surgery.
Those who think weight loss surgery is all about vanity or simple cosmetic changes just don’t understand the procedure. Because not only will weight loss surgery provide the desired (often astonishing) cosmetic changes it can also transform the house-bound individual into one who is re-engaged in every aspect of their life and often cured of a rash of other maladies that were associated with being obese. But just when and how did this incredible medical marvel come about? Below we’ll take a look at the history of weight loss surgery.
A Short History of Bariatric Surgery
Anyone who has struggled with their weight for years knows what a frustrating waste of time dieting can be. It’s not that it doesn’t work for some, but for the obese individual trying to lose hundreds of pounds switching from creamy Italian dressing to oil and vinegar is like trying to bail out the Titanic using a teaspoon. As attempt after dieting attempt fails other problems associated with all the excess weight including respiratory problems, circulatory problems, Type II diabetes, excessive wear and tear on the hip, knee and ankle joints, heart disease, sleep apnea and more begin to take their toll. But the situation is no longer hopeless thanks to gastric bypass surgery.
Early Attempts
Back in the 1950s what became known as the Jejunoileal Bypass (JIB) procedure was first performed on patients in the US. Weight loss with the JIB procedure was predicated on the notion that if enough of the small intestine were removed (all but about 1 foot as it turned out) malabsorption would lead to weight loss. And it did. Often spectacular weight loss. Unfortunately it also tended to lead to a plethora of unforeseen side effects including:
- Electrolyte and mineral imbalances.
- Hair loss and other effects from protein deficiency.
- Osteoporosis.
- Liver disease and acute liver failure.
- Pustular dermatosis.
- Hepatitis, cirrhosis of the liver and death.
It became obvious that as far as JIB was concerned the risks outweighed the benefits and after a few years the procedure was largely relegated to gastric bypass surgery history. The experience did however, produce valuable insights into the issue of malabsorption and the critical need for effective, long term follow up.
Roux-en Y Gastric Bypass
Following the disappointment that accompanied JIB surgery and the need to essentially abandon it a number of doctors and researchers continued to look for a way to provide a safe but radical procedure that could in one fell swoop solve the myriad problems associated with obesity. During the 1960s a fairly common response to serious ulcer conditions was to remove part of the stomach. While we now know this was a well-intentioned by misguided approach to ulcer treatment it did produce one significant side effect that got the attention of a number of doctors looking for a safer, more reliable alternative to JIB surgery: significant, sustainable weight loss. The procedure these ulcer patients underwent was based on a surgical technique developed in 1892 by Dr Cesar Roux to help patients suffering from gastrointestinal obstructions. As fate would have it Dr Roux would not live to see the tremendous influence his innovation would have on the history of weight loss surgery.
Drs Edward Mason and Chikashi Ito decided to adapt Roux’s procedure to the vexing problem of obesity and in 1967 the two performed the first Roux-en Y Gastric Bypass operations. The procedure as it was initially performed was a type of loop bypass which left a much larger portion of the stomach intact. Results from the first few patients to undergo the procedure indicated that the loop configuration often led to bile reflux that produced a number of severe side effects and complications. Revisions were needed.
After several fits and false starts a revised procedure was produced in which the stomach is reduced to a small pouch which limits the amount of food a person can consume and a limb of the intestine is connected directly to that pouch. Today Roux-en Y Gastric Bypass surgery (named for that surgical pioneer of the late 19th century) is the most commonly performed weight loss surgery and has transformed the lives of untold numbers of people the world over. The advantages of RYGB are many and include:
- More reliable weight loss than with some other procedures.
- Far fewer incidents of malabsorption.
- Rapid resolution of associated maladies.
- A high degree of long term success.
Complications from Roux-en Y Gastric Bypass surgery are rare but do occur and include:
- Stretching of the pouch over time (can almost always be avoided by following dietary recommendations of the medical team).
- Breakdown of the staple line.
- Leakage of stomach contents.
- Erosion of the band which seals off the reconfigured stomach.
- Nutritional deficiencies.
Gastric Banding
Gastric Banding is another restrictive form of bariatric surgery that emerged in the aftermath of the JIB experience. It was first successfully performed in 1978. The first gastric banding procedures utilized a 2cm Marlex mesh that was tied around the stomach to divide it into separate chambers with the smaller upper chamber acting as a regulatory device that limited the amount of food that could be eaten at any one time. As results came in from the first patients it became obvious there were issues with dilation of the newly created pouch and so banding techniques were revised and new materials introduced that would hopefully produce more stable long term results.
Dacron, Gortex and finally silicone bands were tried with the latter being the preferred material in use today. An adjustable variant of gastric banding was introduced in the late 20th century and today both adjustable and fixed gastric banding are common forms of weight loss surgery. The advantages of gastric banding are:
- Few if any malabsorption issues.
- The absence of “dumping” syndrome.
- Typically a very short hospital stay.
- It requires less reconstruction of internal organs.
- No staples that might later loosen.
The procedure is not without its potential drawbacks however and possible complications of gastric banding include:
- Band slippage.
- Perforation of the stomach by the band.
- Band erosion or incisional hernia.
- Need for surgical revision.
Sleeve Gastrectomy
During sleeve gastrectomy a large portion of the stomach is cut away and literally removed leaving a stomach roughly the size and shape of a large banana. As with Roux-en Y Gastric Bypass surgery the new smaller stomach is simply unable to hold as much food as it was previously. The smaller stomach also produces less Ghrelin, the hormone largely responsible for regulating appetite. As a result of these two developments the patient has fewer cravings for food and, when they do eat, they are unable to eat anywhere near as much as they did previously. This type of procedure has the added benefit of not affecting the way calories are absorbed by the intestines so malabsorption is a non-issue.
Sleeve gastrectomy is an offshoot of another, earlier procedure in the history of gastric bypass surgery called the duodenal switch. Sleeve gastrectomy is the fastest growing type of bariatric surgery and is sometimes featured as one part of a two-part effort to help extremely obese patients who, for one reason or another, are deemed unsuitable for standard gastric bypass surgery.
Sleeve gastrectomy was at first used exclusively on adults but in recent years has received widespread acceptance as an effective treatment for childhood and adolescent obesity. It is now widely recognized that the benefits of intervening earlier rather than later when it comes to obesity can save a person years of hardship and spare them from developing a slew of comorbidities that will endanger their health and have to be dealt with later anyway. The adoption of the procedure as a weight loss treatment for obese youth was given significant support when studies indicated that normal growth patterns are unaffected by the surgery even in children as young as 5.
There are a number of benefits with sleeve gastrectomy including:
- A reduction in cravings and the ability to feel full faster.
- The natural digestion process is not affected.
- Dumping syndrome is a non-issue.
- There is no slicing and restructuring of the intestine.
- There are no medical devices implanted in the body ala the gastric band.
- Can be performed laparoscopically.
- No chance for food to become trapped as it can with gastric banding.
Complications with this type of bariatric surgery are rare but do occur in a small number of patients. Those complications include:
- Staple leaks.
- Stenosis/strictures.
- Bleeding.
Gastric Bypass History: Conclusion
The history of bariatric surgery is one of constant refinement built on the work of innovative forward thinking medical professionals dedicated to the notion that obesity was not necessarily an incurable condition. Their persistence has resulted in a range of bariatric surgical options that have transformed the lives of tens of thousands of individuals who previously saw little reason to be hopeful for their future.
