From the Knife to the Endoscope-a History of Bariatric Surgery.

PURPOSE OF REVIEW: Current bariatric surgical practice has developed from early procedures, some of which are no longer routinely performed. This review highlights how surgical practice in this area has developed over time. RECENT FINDINGS: This review outlines early procedures including jejuno-colic and jejuno-ileal bypass, initial experience with gastric bypass, vertical banded gastroplasty and biliopancreatic diversion with or without duodenal switch. The role laparoscopy has played in the widespread utilization of surgery for treatment of obesity will be described, as will the development of procedures which form the mainstay of current bariatric surgical practice including gastric bypass, sleeve gastrectomy and adjustable gastric banding. Endoscopic therapies for the treatment of obesity will be described. By outlining how bariatric surgical practice has developed over time, this review will help practicing surgeons understand how individual procedures have evolved and also provide insight into potential future developments in this field.

The evolution of metabolic/bariatric surgery.

Metabolic surgery is defined as "the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain." The evolution of metabolic/bariatric surgery can be viewed from several perspectives: (1) realization that bariatric surgery has always been and will always be metabolic surgery; (2) lessons to be learned from the six dominant procedures; (3) overview of the other operations that have been proposed; (4) discussion of mechanisms of action; (5) physiology of energy metabolism; and (6) introduction to the emerging concept of inflammation. This review will end with thoughts on the present and future outcomes from the knowledge we have gained from metabolic/bariatric surgery. The author concludes with the statement: Metabolic surgery is cognitive surgery.

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.

Evolution of laparoscopic adjustable gastric banding.

This article reviews the use of laparoscopic adjustable gastric banding in the United States today. It comments on the history of the procedure as well as technical aspects of the operation. Short-term and long-term outcomes of the procedure are examined, and the advantages and disadvantages of this procedure in comparison with the laparoscopic gastric bypass are discussed.

When did the esophagus start shrinking? The history of the short esophagus.

Even though the history of this condition extends for almost 100 years, the short esophagus (SE) is still one of the most controversial topics in esophageal surgery with its existence still denied by some distinguished surgeons. We reviewed the evolution behind the diagnosis and treatment of the SE and the persons who wrote its history, from the first descriptions by radiologists, endoscopists, and surgeons to modern treatment.

The history and role of gastric banding.

Gastric banding has emerged in the development of bariatric surgery as an important therapeutic option for morbidly obese patients. Following the major pioneering milestones of Wilkinson and Peloso, who placed a nonadjustable band around the upper part of a patient's stomach in 1978, and Hallberg and Forsell, as well as Kuzmak, who worked on separate continents to develop the clinical application of adjustable gastric bands in the early 1980s, banding entered into widespread use in the mid 1990s, when the innovation of the laparoscopic technique made it possible to insert adjustable bands without open surgery. Today, several institutions have reported long-term (> or =5-year) results with laparoscopic adjustable gastric banding (LAGB). With a small number of exceptions, LAGB efficacy data range from satisfactory to excellent, with some institutions noting annual reoperation rates in the vicinity of 5%, and quality of life scores using the Bariatric Analysis and Reporting Outcome System in the good-to-excellent range in up to 70% of patients. These outcomes, coupled with the fact that LAGB has the best record of safety among the bariatric operations, is reversible, and can be performed at a relatively low cost, have established LAGB as an important tool in the long-term management of morbid obesity.

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.

A brief overview of bariatric surgical procedures currently being used to treat the obese patient.

Obesity has reached an overwhelming high in the United States as well as other developing countries around the world. Alone, approximately 60 million Americans are characterized as obese, and 10 million of them are considered morbidly obese. Many have tried and failed not only to lose the excess weight through fad diets, medically supervised diets, exercise programs, and athletic club memberships, but also to maintain a healthy weight. As a result, weight gain and loss has become a way of life, an unhealthy way of life. This often results in a weight gain of a greater number of pounds than where they started. As a result, many patients and their physicians are looking to weight loss surgery as a permanent solution to the problem of yo-yo dieting. Along with the surgical alterations to the digestive system, nutrition counseling with portion control and regular exercise are part of a comprehensive program for successful long-term weight maintenance. It is the intent of this article to provide the reader with the basic understanding of the normal anatomy of the digestive tract. Then, each surgical procedure will be discussed, enabling the reader to visualize the changes in the digestion and absorption of food. It is these changes in absorption of vitamins and minerals, fats and carbohydrates, and proteins that lead to the various medical complications seen in patients after bariatric surgery.

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.

Surgical intervention for the severely obese.

Severe obesity is a grave disease in the U.S. as well as other industrialized nations. This disease has many ramifications on both an individual and social levels. It affects 12.5 million people in the U.S., according to national survey data. The health risks of severe obesity include hypertension, hyperlipidaemia, cardiomyopathy, diabetes, hypoventilation disorders, increased risk of malignancy, cholelithiasis, degenerative arthritis, infertility, and psychosocial impairments. Medical weight reduction programmes have rarely achieved long-term success. Most authorities now agree that bariatric surgery is the treatment of choice for well-informed and motivated obese patients with acceptable operative risks, who strongly desire substantial weight loss or who have severe impairments because of their weight. Surgery is indicated for patients with a BMI greater than 40 kg/m2, or for those with serious medical co-morbidities and a BMI greater than 35 kg/m2. Three procedures, the adjustable silicone gastric banding (ASGB), vertical gastric banding (VBG), and gastric bypass (GB), have produced the best results to date. Each of these procedures is much more effective than dietary therapies. Each has advantages and disadvantages, with GB producing greater sustained weight loss in the long-term, with a slightly higher risk of metabolic complications. All can be done with surprisingly low operative mortality. The pronounced weight loss induced with these operations can relieve and bring co-morbid diseases, such as diabetes and hypertension, once thought to be only barely controllable, into full long-term remission.