Historical perspectives of bariatric surgery: the jejunoileal bypass and vertical banded gastroplasty.

While neither the jejunoileal bypass nor vertical banded gastroplasty are still performed, many patients still possess this anatomy. They periodically have imaging procedures that need to be performed and interpreted appropriately. It is also important to know what has failed in the past to proceed more intelligently in the future.

The history and evolution of bariatric surgical procedures.

The search for the ideal weight loss operation began more than 50 years ago. Surgical pioneers developed innovative 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 and document outcomes, have led to the evolution of modern bariatric surgery. More recent research has focused on the hormonal and metabolic effects of these procedures. These discoveries at the cellular level will help develop possible mechanisms of weight loss and comorbidity reduction beyond the traditional explanation of reduced food consumption and malabsorption.

[The first bariatric surgery: the single procedure jejunoileal bypass (1954-1980)]. / Une première chirurgie de l'obésité: la longue controverse du court-circuit jéjuno-iléal (1954-1980).

As obesity clearly becomes an epidemic disease, surgery has emerged as its only effective treatment. In the Western World, bariatric surgery is gaining favor, and the number of practitioners rises as rapidly as that of patients. But the recent success of an admittedly radical therapy tends to hide the fact that it faced considerable resistance in its early years, when many physicians considered the practice suspect, if not outright dangerous. In 1980, after 25 years of experimental research, and above all, after an initial attempt to introduce the practice into the clinic, obesity surgery, reducible to mainly one single procedure, the jejunoileal bypass, was widely abandoned. This general failure of a surgical technique, with the arguments that commanded it, is the subject of the present article.

The progress in bariatric surgery.

Morbid obesity, caused by fat tissue accumulation, is a serial multi-factorial chronic disease, with rapidly increasing prevalence in most countries in the world including Poland. Conservative treatment of morbid obesity is almost always unsatisfactory and that is why several surgical methods have been developed. There are four kind of methods: malabsorbtive procedures; restrictive procedures; malabsorbtive/restrictive procedures and experimental procedures. The development of bariatric surgery goes back to 1952 and since that time it has been evolving dynamically. All the surgical methods have benefits and disadvantages. Presently the introduction of minimally invasive surgical techniques seems to be very safe, efficient and cost-effective in treatment for morbid obesity. New methods are also being evaluated, such as gastric myo-electrical stimulation. Bariatric surgery will still be developing until we understand all the factors responsible for it is origin.

The evolution of experimental surgery in the field of morbid obesity.

BACKGROUND: We reviewed the experimental surgery, related to bariatric surgery in laboratory animals, to consider new lines of research. METHODS: The literature on experimental surgery for morbid obesity since the mid-20th century was reviewed, focusing on existing techniques (malabsorptive, restrictive, mixed and experimental) and their associated metabolic component. RESULTS: In the field of laparoscopy, there is a clear tendency for large laboratory animals such as pigs to be used. These are useful for developing and perfecting techniques. A second area of animal experimentation concentrates on the relationship between metabolism and surgery in order to find improvements in the co-morbidities associated with morbid obesity. A third area of research focuses on manipulating intake via central and vagal control. CONCLUSION: Further studies are needed to combine traditional and recently developed techniques of experimental surgery with the mechanisms that determine the physiopathology, metabolism and regulation of intake of morbidly obese patients. To accurately determine metabolic behavior and avoid drawing conclusions that are not very significant, these studies should be carried out on obese animals and focus on the co-morbidities associated with morbid obesity.