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A brief history of bariatric surgery

DOI:10.1016/j.pbj.2017.01.008
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Gil Faria at Hospital Pedro Hispano
Gil Faria
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Abstract

Obesity has been a problem since medieval times, but only in the latter 20 years it has been recognized as a worldwide epidemic. Treating obesity is challenging and difficult, but surgery has led to an increased success and novel insights on the pathophysiology of obesity. Several surgical techniques have been developed during the last 50 years and the advent of laparoscopic surgery has increased its safety, efficacy and demand from the population. Nowadays, the ever increasing and successful use of novel techniques have been responsible for several changes in the established treatment paradigms.
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Please
cite
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article
in
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as:
Faria
GR.
A
brief
history
of
bariatric
surgery.
Porto
Biomed.
J.
2017.
http://dx.doi.org/10.1016/j.pbj.2017.01.008
ARTICLE IN PRESS
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PBJ-59;
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Pages
3
Porto
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Porto
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ht
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Rostrum
A
brief
history
of
bariatric
surgery
Gil
R.
Fariaa,b,∗
aDepartment
of
Surgery,
Unidade
de
Investigac¸
ão
em
Cirurgia
Digestiva
e
Metabólica,
Centro
Hospitalar
do
Porto,
Hospital
de
Santo
António,
Porto,
Portugal
bCenter
for
Health
Technology
and
Services
Research
(CINTESIS),
Instituto
de
Ciências
Biomédicas
de
Abel
Salazar,
Porto,
Portugal
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
22
April
2016
Accepted
19
January
2017
Available
online
xxx
Keywords:
Bariatric
surgery
History
of
medicine
Gastric
bypass
Gastric
sleeve
Mini
gastric
bypass
a
b
s
t
r
a
c
t
Obesity
has
been
a
problem
since
medieval
times,
but
only
in
the
latter
20
years
it
has
been
recognized
as
a
worldwide
epidemic.
Treating
obesity
is
challenging
and
difficult,
but
surgery
has
led
to
an
increased
success
and
novel
insights
on
the
pathophysiology
of
obesity.
Several
surgical
techniques
have
been
developed
during
the
last
50
years
and
the
advent
of
laparoscopic
surgery
has
increased
its
safety,
efficacy
and
demand
from
the
population.
Nowadays,
the
ever
increasing
and
successful
use
of
novel
techniques
have
been
responsible
for
several
changes
in
the
established
treatment
paradigms.
©
2017
PBJ-Associac¸ ˜
ao
Porto
Biomedical/Porto
Biomedical
Society.
Published
by
Elsevier
Espa˜
na,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/
licenses/by-nc-nd/4.0/).
Historical
reports
claim
that
the
first
bariatric
surgery
was
per-
formed
in
Spain,
in
the
10th
century.
D.
Sancho,
king
of
Leon
was
reported
to
be
such
an
obese
man
that
he
could
not
walk,
ride
a
horse
or
pick
up
a
sword.
This
led
him
to
lose
his
throne.
He
was
then
escorted
by
his
grandmother
to
Cordoba
to
be
treated
by
the
famous
Jewish
doctor
Hasdai
Ibn
Shaprut.
He
sutured
the
kings’
lips
who
could
only
be
fed
on
a
liquid
diet
through
a
straw,
consist-
ing
of
teriaca:
a
mixture
of
several
herbs,
including
opium,
whose
side
effects
stimulated
weight
loss.
King
Sancho
lost
half
his
weight,
returned
to
Leon
in
his
horse
and
regained
his
throne! 1,2
Even
though
specific
weight
loss
interventions
are
sparsely
reported
throughout
the
literature
in
the
second
half
of
the
20th
century,
they
remained
in
obscurity
until
the
1990s.
Indeed,
it
was
only
when
the
obesity
epidemics
got
finally
recognized
that
the
medical
community
started
considering
surgical
approaches
to
tackle
it.3,4
The
first
metabolic
surgery
is
attributed
to
Kremen
in
1954:
the
jejuno-ileal
bypass.5It
consisted
of
an
anastomosis
between
the
proximal
jejunum
and
distal
ileum,
bypassing
much
of
the
small
intestine
and
was
devised
to
treat
severe
forms
of
dyslipide-
mia.
This
was
a
surgery
with
major
metabolic
consequences,
such
that
most
patients
suffered
from
severe
diarrhea
and
dehydration
and
thus,
it
was
not
yet
ready
for
mainstream
adoption.
Henry
Buchwald,
later
demonstrated
that
ileal
bypass
(with
a
jejuno-colic
∗Correspondence
address:
Center
for
Health
Technology
and
Services
Research
(CINTESIS),
Centro
Hospitalar
do
Porto,
Hospital
de
Santo
António,
Departamento
de
Cirurgia,
Largo
do
Prof.
Abel
Salazar,
4099-001
Porto,
Portugal.
E-mail
address:
gilrfaria@gmail.com
anastomosis)
had,
indeed
an
effect
on
lowering
the
lipid
levels
in
patients
with
familiar
hypercholesterolemia
and
that
this
effect
was
sustainable
for
many
years.6,7 Several
modifications
of
these
intestinal
bypass
procedures
were
reported
in
the
1960s
and
70s,
but
none
of
them
gained
widespread
acceptance.
In
1966,
Dr.
Mason,
a
surgeon
from
the
University
of
Iowa,
noting
that
patients
with
sub-total
gastrectomy
for
cancer
lost
a
consid-
erable
amount
of
weight,
proposed
the
first
“bariatric
surgery”:
the
first
gastric
bypass.8Initially
it
consisted
of
an
horizontal
gas-
tric
transection
with
a
loop
ileostomy,
but
it
was
later
optimized
to
smaller
gastric
pouches
and
stoma
sizes.9Due
to
severe
bile
reflux,
the
reconstruction
was
proposed
with
a
“Roux-en-Y”
loop,10
which
diverts
the
bile
from
the
stomach
and
esophagus
and
has
become
the
surgical
standard.
Compared
to
jejuno-ileal
bypass,
gastric
bypass
procedures
resulted
in
less
diarrhea,
kidney
stones
and
gallstones
and
improvement
in
liver
fat
content.10
Several
modifications
to
this
technique
were
proposed
to
improve
weight
loss,
such
as
the
Fobi-Capella
banded
gastric
bypass,
which
consisted
in
the
application
of
a
ring
to
the
gas-
tric
pouch,
in
order
to
limit
its
enlargement
and
possible
weight
regain.11,12 Pouch
sizes
had
been
correlated
to
weight
loss.
Accord-
ing
to
Laplace’s
law,
the
larger
the
pouch,
the
larger
the
wall
tension,
which
would
lead
to
further
dilatation.
Thus,
small
pouch
sizes
(<30
ml)
have
become
the
norm.3
In
1994,
the
first
laparoscopic
gastric
bypass
was
performed
by
Alan
Wittgrove13 and
the
exponential
growth
of
bariatric
and
metabolic
surgery
had
definitely
started.
It
is
estimated
that
in
2011,
more
than
340,000
procedures
have
been
performed
worldwide.14 Currently,
the
most
common
technique
involves
the
creation
of
a
small
gastric
pouch,
a
biliary
limb
of
70
cm
and
a
Roux
http://dx.doi.org/10.1016/j.pbj.2017.01.008
2444-8664/©
2017
PBJ-Associac¸ ˜
ao
Porto
Biomedical/Porto
Biomedical
Society.
Published
by
Elsevier
Espa˜
na,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please
cite
this
article
in
press
as:
Faria
GR.
A
brief
history
of
bariatric
surgery.
Porto
Biomed.
J.
2017.
http://dx.doi.org/10.1016/j.pbj.2017.01.008
ARTICLE IN PRESS
G Model
PBJ-59;
No.
of
Pages
3
2
G.R.
Faria
/
Porto
Biomed.
J.
2017;xxx(xx):xxx–xxx
limb
of
150
cm,
although
several
surgeons
have
developed
slight
adaptations
to
the
technique
and
limb
lengths.
Laparoscopic
Roux-en-Y
gastric
bypass
is
a
technically
chal-
lenging
surgery
with
a
steep
learning
curve
and
with
potential
leaks
at
2
anastomosis.
In
an
attempt
to
make
it
simpler
and
safer,
Rutledge
developed
the
Mini-Gastric
Bypass15 (or
omega-
loop
or
single-anastomosis
gastric
bypass),
consisting
of
a
longer
gastric
pouch
and
an
antecolic
loop
gastrojejunostomy
150–200
cm
distal
to
the
angle
of
Treitz.
His
first
surgery
was
in
1997
and
although
Rutledge
published
his
experience
with
thousands
of
patients,16 for
several
years
this
technique
has
suffered
the
criticisms
of
biliary
reflux
and
risk
of
malignancy.17 Increasing
experience
with
this
technique
worldwide
has
reduced
the
con-
cerns
and
in
the
latter
years
it
has
gained
wide
acceptance
among
many
surgeons.18,19 Its
results
are
reported
to
be
even
supe-
rior
to
RYGB,
due
to
its
longer
biliary
limb
and
some
degree
of
malabsorption.20,21
Purely
restrictive
procedures
were
also
developed
as
an
alter-
native
to
gastric
bypass.
These
techniques
were
thought
to
have
less
surgical
morbidity
and
mortality
and
to
be
simpler
to
per-
form.
However,
patients
need
to
be
highly
motivated,
as
the
surgical
result
is
dependent
on
a
mechanism
of
early
satiety.
If
the
patients
consume
liquid
or
soft,
energetically
dense
foods,
distention
of
the
gastric
fundus
does
not
occur
and
patients
do
not
achieve
an
early
satiety.
As
early
as
1977,
Rodgers
et
al.
reported
on
their
experience
with
17
cases
of
jaw
wiring.
The
early
weight
loss
was
comparable
to
gastric
bypass
procedures,
however
patients
regained
weight
after
the
wires
were
removed.22
The
first
restrictive
procedure
on
the
stomach
consisted
of
a
“Nissen-type”
gastric
wrap,
proposed
by
Wilkinson.23 Since
then,
several
gastroplasties
had
been
proposed.
The
most
accepted
pro-
cedure
was
the
vertical
banded
gastroplasty,
proposed
by
Mason
in
1982.24 It
combined
a
vertical
stapled
gastroplasty
with
a
banded
outlet.
The
same
principle
was
developed
by
putting
a
band
around
the
stomach
and
thus
creating
a
narrow
passage
from
the
proxi-
mal
to
the
distal
stomach.
The
great
improvement
with
the
gastric
band
occurred
in
1986,
when
Kuzmak25 allowed
the
band
to
be
adjusted
without
the
need
for
further
surgical
explorations.
There
was
an
exponential
increase
in
the
number
of
surgeries
performed
after
the
introduction
of
the
laparoscopic
technique.
Although
the
first
report
dates
back
to
1993
by
Forsell,26 the
first
laparoscopic
gastric
band
was
placed
by
Cadière
in
1992.27 It
was
an
easy,
fast,
reproducible
technique
with
low
perioperative
morbidity,
almost
abandoned
in
the
latter
years
due
to
long-term
complications
and
failure
in
weight
loss.
On
the
other
hand,
some
surgeons
believed
that
malabsorption
was
required
for
successful
weight
loss.
Due
to
the
complications
associated
with
jejuno-ileal
bypasses
(diarrhea,
liver
failure
and
severe
dehydration),
Scopinaro
proposed
a
significant
change
to
the
technique.
After
initial
studies
in
dogs,
starting
in
197628 he
later
published
the
experience
on
human
subjects
that
underwent
bilio-
pancreatic
diversion
(still
called
the
Scopinaro
procedure).29 The
surgical
technique
included
a
distal
gastrectomy
with
a
long
Roux
limb
and
a
short
(50
cm)
common
channel.
Scopinaro
reported
weight
loss
greater
than
79%
maintained
up
to
25
years,30 because
patients
absorption
capacity
was
limited
to
∼1250
kcal/day.
He
also
reported
a
low
complication
rate,
mostly
with
anemia,
protein
mal-
nutrition
and
stomal
ulceration.
However,
Scopinaro
results
were
not
replicated
elsewhere
and
several
modifications
to
his
technique
were
proposed.
The
most
accepted
of
this
alternative
is
Duodenal
Switch,
reported
by
Marceau31 and
Hess.32 The
changes
included
substituting
the
distal
gastrectomy
for
a
vertical
(sleeve)
gas-
trectomy,
thus
preserving
vagal
innervation
and
pyloric
function.
Then
proceeding
with
a
duodeno-ileal
anastomosis
at
100
cm
from
the
ileo-cecal
valve
(elongating
the
common
alimentary
channel).
This
alternative
technique
of
bilio-pancreatic
diversion
yielded
the
same
weight
loss
with
a
lower
complication
rate.31
Biliopancreatic
diversions
are
very
complex
surgeries
that
still
remain
a
challenge
even
to
the
most
experienced
laparoscopic
sur-
geons.
For
this
reason,
Gagner
proposed
that
it
could
be
done
as
a
staged
procedure,
starting
with
a
vertical
gastrectomy
(sleeve)
and
proceeding
with
the
duodenal
switch.33 The
challenge
of
laparo-
scopic
surgery
in
super
superobese
patients
(BMI
>
60
kg/m2)
had
led
to
the
proposal
of
a
staged
procedure
in
which
sleeve
gas-
trectomy
would
also
be
the
first
part34 of
a
gastric
bypass.
The
observation
that
these
patients
lost
a
significant
amount
of
excess
weight
(56%),
and
the
previous
experience
in
the
UK
with
the
“Magenstrasse
and
Mill”
operation35 (a
vertical
gastric
partitioning
without
gastric
resection,
with
a
small
curvature
centered
sleeve),
led
some
authors
to
propose
sleeve
gastrectomy
as
a
stand-alone
surgery
for
the
treatment
of
obesity.
Sleeve
gastrectomy
allowed
for
a
significant
weight
loss
with
low
perioperative
morbidity,
maintained
digestive
continuity
and
was
easy
converting
to
other
bariatric
surgeries.36 This
surgery
has
proven
to
be
safe
(even
if
sleeve
fistulas
are
harder
to
treat,
due
to
the
high-pressure
system
in
the
gastric
reservoir)
and
although
more
long-term
studies
are
required,
it
has
so
far
resisted
the
test
of
time
and
the
concerns
about
pouch
dilatation.37–39
As
we
have
seen,
bariatric
surgery
has
come
a
long
way
since
the
first
jejuno-ileal
bypasses,
and
bariatric
operations
have
led
the
way
to
a
more
thorough
knowledge
of
digestive
physiology.
The
growth
of
laparoscopic
surgery
with
its
reduced
complications,
shorter
hospital
stay,
faster
recovery,
less
morbidity
and
improved
results
has
led
to
an
ever
increasing
patient
demand.3
Disclosures
The
author
has
nothing
to
disclose.
Conflicts
of
interest
The
author
has
no
conflicts
of
interest
to
disclose.
Funding
There
were
no
external
sources
of
funding
for
this
manuscript.
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Please
cite
this
article
in
press
as:
Faria
GR.
A
brief
history
of
bariatric
surgery.
Porto
Biomed.
J.
2017.
http://dx.doi.org/10.1016/j.pbj.2017.01.008
ARTICLE IN PRESS
G Model
PBJ-59;
No.
of
Pages
3
G.R.
Faria
/
Porto
Biomed.
J.
2017;xxx(xx):xxx–xxx
3
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... Esse excesso de gordura é um problema desde os tempos medievais, mas apenas nos últimos 20 anos foi reconhecida como uma epidemia mundial. Tratar a obesidade é desafiador (Faria, 2017). À vista disso, o tratamento mais eficaz para o controle do peso tem se apresentado como a Cirurgia Bariátrica (CB), que aliada à redução das complicações associadas tem levado ao aumento de sua performance (Nicoletti et al., 2017). ...
... No entanto, a famosa bariátrica já percorreu um longo caminho e abriram portas para um conhecimento mais completo da fisiologia do metabolismo energético que está envolvido na perda de peso (Faria, 2017). ...
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... 34 The procedures of bariatric surgery have gradually evolved; from the initial metabolic surgery attributed to Kremen in 1954, the first gastric bypass in 1967 to the gastric sleeve; the surgery most used currently. 35 Bariatric surgery improves many of the functional, anatomical and metabolic alterations, as well as improving the quality of life. [36][37][38] Although the long-term results are variable and not conclusive, it has been mentioned that all types of bariatric surgery reduce weight, BMI and various co-morbidities better than medical procedures to lose weight. ...
Update on anesthesia for patients undergoing post-bariatric body contouring surgical procedures
Article
  • Sep 2020
Individuals who have undergone bariatric surgery and have lost a considerable amount of weight tend to seek consultation with plastic surgeons for body contouring surgery. This growing population is overweight, and they still have some of the co-morbidities of obesity, such as hypertension, ischemic heart disease, pulmonary hypertension, sleep apnea, iron deficiency anemia, hyperglycemia, among other pathologies. They should be considered as high anesthetic risk and therefore, should be thoroughly evaluated. If more than one surgery is planned, a safe operative plan must be defined. The anesthetic management is adjusted to the physical condition of the patient, the anatomical and physiological changes, the psychological condition, as well as the surgical plan. Anemia is a frequent complication of obesity and bariatric procedures and should be compensated with appropriate anticipation. Pre-anesthetic medications may include benzodiazepines, alpha-2 agonists, anti-emetics, antibiotics, and pre-emptive analgesics. Regional anesthesia should be used whenever possible, especially subarachnoid blockade, since it has few side effects. General anesthesia should be left as the last option and can be combined with regional techniques. It is prudent to use conscious sedation for facial and neck surgery, maintaining strict control, especially with respect to the airway management. Thromboprophylaxis is mandatory and should continue for several days after the operation.
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... Since 1994, video-laparoscopy has been utilized to perform bariatric surgery, which is a less intrusive treatment that results in a lower rate of early and late problems as compared to conventional approaches (4). Bariatric surgery's goal is to lower the capacity of the stomach cavity, resulting in the development of satiety following the absorption of a small amount of food. ...
Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study
Article
Full-text available
  • Mar 2023
Background: Morbid obesity may cause a restrictive condition. General Anesthesia (GA) and supine posture both decrease lung capacity and functional residual capacity (FRC), altering the ventilation/perfusion ratio and raising the pulmonary shunt. Objectives: To evaluate the impact of recruitment maneuver (RM) and transversus abdominis plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, opioid requirements, and pain score assessed after surgery. Methods: This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients received a standardized postoperative analgesia regimen. Group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal insufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results: Forced vital capacity (FVC) and Forced expiratory volume (FEV1) were significantly higher after group IV operation than in other groups. Intraoperative PaO2 and PaO2/FiO2 were significantly higher in groups III and IV compared to other groups. The numerical rating scale (NRS) at 1, 2, 4, 6, and 12h was significantly decreased in groups II and IV compared to other groups. Morphine consumption was significantly lower in groups II and IV compared to other groups. Conclusions: TAP block combined with RM had better postoperative pulmonary function tests. Intraoperative oxygenation was higher in RM.
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... Obesity is a serious medical condition of having a body mass index of 30 or higher, and it has been rising rapidly among adults and children in the last 10 years. It is linked to chronic co-morbidities and higher chances of early mortality [1], which warrants immediate interventions in some cases, some of which can be surgical and referred to as bariatric or metabolic surgeries [2]. The eligibility criteria for bariatric surgeries were determined by the National Institutes of Health to avoid unnecessary surgeries [3], and only 1% of those eligible undergo surgery, potentially due to the fear of encountering surgical complications [1]. ...
Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis
Article
Full-text available
  • Sep 2022
Worsening hiatus hernia (HH) symptoms have been well recognized as a complication of gastric banding, however, it has not yet been explored whether gastric banding plays a role in the development of HH de novo in patients undergoing gastric banding. From the 696 studies identified, five studies met the eligibility criteria and were included. Data was extracted from PubMed, Embase, Medline, HMIC, and Web of Science databases. The pooled complication rate was evaluated along with 95% confidence intervals (95% CIs). The meta-analysis was performed using the Cochrane RevMan tool (Cochrane, London, UK). Heterogeneity was tested using the I2 index for each outcome. All the included studies assessed HH incidence among followed-up patients who needed a re-operation for upper gastrointestinal symptoms. Between-study variability was high (I2 = 94%, Chi2 = 68.92, df = 4, < 0.00001, Tau2=1.91). Complication rate ranged between 0.24% to 5.55%; pooled complication rate was 2.17% CI 95% (0.90 - 3.44%) P = 0.0008. The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least. Further research is needed to underpin the mechanism and confirm causation. However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.
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... It is currently a pandemic and the forecasts indicate that it is on the rise, what is of concern at the public health level is that, due to its affectation in comorbidities, it causes significant expenditure in the health institutions of our country. 1,2 The treatment requires the intervention of multiple specialists and it has been documented that surgery has high percentage of effectiveness. During the evolution of bariatric procedures, key points have been found that significantly improve weight loss and the resolution of comorbidities. ...
Short-term outcomes after long inverted versus short standard biliopancreatic limb in Roux-en-Y gastric bypass
Article
Full-text available
  • Sep 2022
Background: Obesity is a public health issue that affects the entire world and it is rising. Roux-en-Y gastric bypass is one of the most common bariatric procedures and it can reach a significant and sustained excess weight loss and efficient comorbidity control. The main objective was to compare short-term outcomes between standard versus long biliopancreatic limb gastric bypass patients.Methods: it was a retrospective, comparative, descriptive, single-center study. We evaluated obese patients that underwent a laparoscopic Roux-en-Y gastric bypass with standard or long biliopancreatic limb in Centro Medico ABC, Mexico City, and compared general demographics, weight loss, excess weight loss, comorbidities and quality of life.Results: Of 50 patients analyzed, 24 were in the standard gastric bypass (S-GB) and 26 in the long biliopancreatic limb (LBPL-GB). Mean weight loss in the S-GB group was 33.1±12.1 kg and in the LBPL-GB was 40.2±12.6 kg with a difference of 7.1 kg. The percentage of excess weight loss (%EWL) was 72.5±14% in S-GB and 72.9±19% in LBPL-GB, with a difference of 0.4% in the 12 months of follow-up. There was a complete reduction of hypoglycemic drugs in 80% in the S-GB group and 100% in the LBPL-GB group.Conclusions: With this modification of the technique, we achieved important outcomes in regard of comorbidities, without affecting drastically weight loss or the EWL. This procedure is safe and feasible.
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... Presente desde os tempos medievais (Faria, 2017), a obesidade é uma doença crônica caracterizada por elevação da massa de gordura corporal, tendo como causa a ingestão excessiva de calorias alimentares. Em crescente prevalência e incidência, tornou-se um verdadeiro problema de saúde pública mundial (Bastos et al., 2013;Rye et al., 2018;Ryan & Kahan,, 2018). ...
Análise da evolução da composição corporal segmentar em bariátricos com reganho de peso submetidos à terapêutica farmacológica com liraglutida
Article
Full-text available
  • Aug 2022
A obesidade é uma doença crônica, multifatorial, responsável por diversas morbidades, sendo a cirurgia bariátrica uma alternativa eficiente para a perda de peso. Cerca de 20% a 25% dos pacientes, mesmo perdendo peso após o procedimento, tendem a apresentar reganho de peso após o segundo ano. Este estudo teve como objetivo central analisar a evolução da composição corporal segmentar em bariátricos com reganho de peso e submetidos à terapêutica farmacológica com liraglutida. Trata-se de um estudo retrospectivo, longitudinal, por meio de análise de dados em prontuário de uma instituição especializada em terapêutica clínica e cirúrgica da obesidade. A amostra foi composta por 22 pacientes bariátricos atendidos entre janeiro de 2016 a dezembro de 2019. Foram coletados dados antropométricos de impedanciometria segmentar, bem como dados da evolução clínica referente ao tratamento proposto. Em ambas as doses, a perda de massa se mostrou relevante em todos os segmentos, apontando significância. O IMC reduziu 9,3% em todos os pacientes nas 24 semanas analisadas. Com 2,4mg/dia de liraglutida, houve perda de 7,2% do peso e, com dose de 3,0mg/dia, esta perda foi de 9,84%. Considerando ambas as doses, a perda de peso geral foi de 9,2%. As porcentagens de diferenças médias de gordura foram similares entre o tronco e os membros. Com relação à massa magra, embora não houve significância estatística, encontrou-se uma significância clínica de proteção.
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... Realizó la GML en un grupo de 7 pacientes con un IMC mayor a 58 kg/m 2 comprobando el éxito en baja de peso. Luego plantea la posibilidad de hacer ese procedimiento en forma exclusiva, lo que ganó gran popularidad y actualmente es la intervención más practicada en el mundo 9,11 . ...
Evolución de la cirugía bariátrica en Chile y el mundo
Article
Full-text available
  • Dec 2021
Obesity is recognized as “the great epidemic” of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.
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... В настоящее время бариатрическая хирургия -самый эффективный метод снижения массы тела, частоты ассоциированных с ожирением заболеваний и смертности у пациентов с морбидным ожирением (МО) [1,2]. Анализ результатов хирургического лечения ожирения установил, что данный вид терапии безопасен и эффективен при лечении МО со средним уровнем смертности 0,3%, что сопоставимо с операциями по замене тазобедренного сустава или лапароскопической холецистэктомией (0,35-0,6%) [3]. ...
The problem of identification and correction of micro- and macronutrients deficiency after bariatric surgery: A review
Article
Full-text available
  • Jun 2022
Surgical treatment of obesity is one of the most effective ways to reduce and maintain body weight for a long time. Depending on the type of operation, patients with different frequency develop malabsorption syndrome. As a result, in individuals who have received this type of medical care, at different times after bariatric surgery, micro and macronutrient deficiencies may be detected. Therefore, the long-term safety of this treatment method is associated with the correction of vitamin and trace element deficiencies both before and after bariatric intervention. This review highlights the most common deficiencies that are found in obese patients, as well as methods for their diagnosis and treatment.
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Complications After Metabolic and Bariatric Operations
Chapter
  • Sep 2022
A 45-year-old woman with a past surgical history significant for laparoscopic Roux-en-Y gastric bypass 6 years earlier presents with diffuse abdominal pain and distension for 24 h. She has had similar intermittent symptoms over the past year, but this episode has lasted for longer than her typical duration. She has lost over 105 pounds from her heaviest with a current BMI of 29. Computed tomography demonstrates small bowel dilatation of the Roux limb with swirling of the associated mesenteric vessels. Emergent laparoscopic exploration by the on-call acute care surgeon showed the Roux limb had herniated through a defect formed by the potential space between the transverse mesocolon, retroperitoneum, and the Roux limb mesentery. The small bowel was repositioned and the defect was closed with running suture. She had an uneventful recovery.KeywordsBariatric surgeryGastric bandGastric bypassSleeve gastrectomyMarginal ulcers
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Is development in bariatric surgery in Germany compatible with international standards? A review of 16 years of data
Article
  • Aug 2022
Bariatric surgery has expanded tremendously internationally over the past decade. In recent years, bariatric surgery has experienced a significant growth in Germany. However, the question arises as to whether this development is in line with international developments or whether there is still room for improvement that could be challenged. 63,990 primary bariatric procedures recorded in the German Bariatric Surgery Registry (GBSR) were analyzed from 2005 to April 2021. The distribution of procedures according to different variants was analyzed and presented. In the last 16 years, 17 different procedures have been performed. The most common surgical procedure was sleeve gastrectomy (SG), followed by Roux-Y gastric bypass (RYGB) (42%). Adjustable gastric banding (AGB) has declined over time, from 23.5% in the first 5 years to 0.2% in recent years. In comparison, omega-loop gastric bypass has increased over the past 5 years (from 0.4% in the first 5 years to 5.9% in the last 5 years). Laparoscopic procedures have accounted for 96.4% of all bariatric surgeries in recent years. The frequency of some procedures has decreased and some bariatric procedures have lost significance. Overall, bariatric surgery in Germany has developed positively compared to the international trend. Nevertheless, there is one area that needs to be optimized: the development of robotic bariatric surgery, which crawls behind in Germany compared to other countries. To establish the technology in bariatric surgery in a timely manner, a balance must be found between cost neutrality and patient-oriented applications.
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The Sleeve Bypass Trial: A multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life
Article
Full-text available
  • Aug 2015
Obesity is an increasing disease worldwide. Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold standard surgical technique. Laparoscopic Sleeve Gastrectomy (LSG) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract. The aim of this study is to evaluate the efficiency of both techniques. Our hypothesis is that LSG has a similar percentage excess BMI loss (%EBMIL) after 5 years compared to LRYGB. The Sleeve Bypass Trial is a randomized multicentre clinical trial: patients eligible for bariatric surgery are randomized to either LSG or LRYGB. Patients with a body mass index (BMI) ≥ 40 kg/m(2) or BMI 35 kg/m(2) with obesity related comorbidity (T2 DM, sleep apnoea, hypertension) are eligible for randomization. At randomization patients are stratified for centre, sex, T2 DM and BMI ≥ 50 kg/m(2). A total number of 620 patients will be enrolled and equally (1:1) randomized to both treatment arms. Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial. The primary endpoint is the 5-year weight loss (%EBMIL) of LSG and LRYGB. Secondary endpoints are resolution of obesity related comorbidity, complications, revision bariatric surgery and quality of life (QOL) defined in various questionnaires. Long-term %EBMIL between the two treatment strategies used to be in favour of LRYGB, but more recent results throughout the world show similar %EBMIL in both techniques. If weight loss is comparable, obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future. Dutch Trial Register: NTR 4741.
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Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass
Article
Full-text available
  • Feb 2015
Background: Laparoscopic sleeve gastrectomy (LSG) is considered a primary bariatric surgery and is increasingly being performed worldwide; however, long-term data regarding the durability of this procedure are inadequate. Here, we report the long-term results of LSGs in comparison to those of gastric bypass surgeries. Methods: A prospectively collected bariatric database from Ming-Shen General Hospital was retrospectively studied. Five hundred nineteen morbidly obese patients (mean age 36.0 ± 9.1 years old (14-71), 74.6 % female, mean body mass index (BMI) 37.5 ± 6.1 kg/m(2)) underwent LSG as a primary bariatric procedure from 2006 to 2012 at our institute. The operative parameters, weight loss, laboratory data, and quality of life were followed. Another two matched groups of laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic single anastomosis (mini-) gastric bypass (SAGB) patients who were matched in terms of age, sex, and BMI were recruited for comparisons. Results: The mean surgical time for LSG was 113.5 ± 31.3 min, and the mean blood loss was 49.1 + 100.9 ml. The rate of major complications was 1.6 %, and the average length of the postoperative stay was 3.0 ± 1.7 days. The operation times of the RYGB patients were longer than those of both the LSG and SAGB patients. The RYGB and SAGB patients experienced higher major complication rate than the LSG patients. The weight loss of the LSG patient at 5 years was 28.3 + 8.9 %, and the mean BMI was 27.1 + 4.3. The RYGB patients exhibited a 5-year weight loss similar to the LSG patients, and the SAGB patients exhibited greater weight loss than both of the other groups. Both the RYGB and SAGB patients exhibited significantly better glycemic control and lower blood lipids than the LSG patients, but the LSG patients exhibited a lesser micronutrient deficiency than the RYGB and SAGB groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure. Conclusions: LSG appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.
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Ileal Bypass in Patients With Hypercholesterolemia and Atherosclerosis
Article
  • May 1966
In 1962, animal experiments in rabbits and pigs demonstrated that subtotal ileal bypass would lead to a marked decrease in cholesterol absorption capactiy and a sharp decline in circulating-cholesterol levels.1 This induced lowering of the blood cholesterol level endured for the duration of the bypass period. Further work showed that although the entire small intestine has the capability to absorb cholesterol, greater amounts are taken up by the ileum. Too, the intestinal transit time plays a role in cholesterol absorption. Finally, it appears that the maximal circulating-cholesterol reduction obtainable by a limited intestinal bypass can best be achieved by subtotal ileal bypass with bypass including the ileocecal valve.2 The finding of ileal preference in cholesterol absorption corroborates the earlier results of Byers and associates.3 Our analysis, by statistical comparison of age and sex matched populations of human controls with patients who had undergone ileal resections for causes
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The Response of the US Centers for Disease Control and Prevention to the Obesity Epidemic
Article
The recognition of the obesity epidemic as a national problem began in 1999 with the Centers for Disease Control and Prevention's (CDC's) publication of a series of annual state-based maps that demonstrated the rapid changes in the prevalence of obesity. Increasing rates of obesity had been noted in earlier CDC studies, but the maps provided evidence of a rapid, nationwide increase. The urgent need to respond to the epidemic led to the identification of state targets and the first generation of interventions for obesity prevention and control. The CDC's role was to provide setting- and intervention-specific guidance on implementing these strategies, and to assess changes in targeted policies and behaviors. The CDC's efforts were augmented by Congressional funding for community initiatives to improve nutrition and increase physical activity. Complementary investments by Kaiser Permanente, the Robert Wood Johnson Foundation, and the Institute of Medicine improved the evidence base and provided policy recommendations that reinforced the need for a multisectoral approach. Legislative, regulatory, and voluntary initiatives enacted by President Obama's administration translated many of the strategies into effective practice. Whether current efforts to address obesity can be sustained will depend on whether they can be translated into greater grass-roots engagement consistent with a social movement. Expected final online publication date for the Annual Review of Public Health Volume 36 is March 18, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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Single anastomosis or mini-gastric bypass: Long-term results and quality of life after a 5-year follow-up
Article
  • Sep 2014
Background Laparoscopic mini-gastric bypass (LMGB) is an alternative to the laparoscopic Roux-en-Y gastric bypass (LRYGB), which is considered to be the gold standard in the treatment of morbid obesity. Objectives Present five-year results of 175 patients who had undergone a LMGB between October, 2006 and October, 2008. Setting University public hospital, France. Methods Complete follow-up was available in 126 of 175 patients (72%) who had LMGB. Mortality, morbidity, weight loss, co-morbidities and quality of life were assessed. Weight loss was determined as a change in body mass index (BMI) and percent excess BMI loss (%EBMIL). Quality of life in the treatment group was analyzed using the Gastrointestinal Quality of Life Index (GIQLI) and was compared to a retrospectively case matched preoperative control group. Results There were no deaths. 13 patients (10.3%) developed major complications. Marginal ulcers occurred in 4% of patients. Incapacitating biliary reflux developed in two (1.6%) who required conversion into RYGB. Gastric pouch dilation occurred in four patients (3.2%) and inadequate weight loss with severe malnutrition in two (1.6%). At five years, mean BMI was 31±6 kg/m2 and mean %EBMIL was 71.5±26.5%. Postoperative GIQLI score of the treatment group was significantly higher than preoperative score of the control group (110.3±17.4 vs. 92.5±15.9, p<0.001). Social, psychological and physical functions were significantly increased. No significant differences were found in gastro-esophageal reflux or diarrhea symptoms between the two groups. Long-term follow-up showed an improvement in all co-morbidities. Conclusions At five years, LMGB was safe, effective and provided interesting quality of life results.
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Single-Anastomosis Gastric Bypass (SAGB): Appraisal of Clinical Evidence
Article
  • Jul 2014
Single-anastomosis (mini-) gastric bypass (SAGB) was proposed by Dr. Robert Rutledge. Criticism and prejudice against this procedure was raised by surgeons who preferred a more difficult procedure, laparoscopic Roux-en-Y gastric bypass (RYGB). Increasing data indicates the procedure is an effective and durable bariatric procedure. SAGB has lower operation risks compared to RYGB. The weight loss is better after SAGB because of a greater malabsorptive component than RYGB, but SAGB had a higher incidence of micronutrient deficiencies. Randomized controlled trial and long-term data demonstrate that SAGB can be regarded as a simpler and safer alternative to RYGB. We propose this procedure to be renamed "single-anastomosis gastric bypass (SAGB)" because the key feature of SAGB is the "single anastomosis" compared with the two anastomoses of RYGB.
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Long-term Outcomes of Laparoscopic Sleeve Gastrectomy as a Primary Bariatric Procedure : “Long-term outcomes of sleeve gastrectomy”
Article
  • Apr 2014
Background: Laparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure. Methods: Retrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test. Results: A total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16-65), median preoperative BMI was 34.9 kg/m(2) (interquartile range [IQR], 33.3-37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m(2) (IQR: 25.8-31.9) and 62.9% (IQR: 45.3-89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI<35 kg/m(2), 75% of BMI 35-40 kg/m(2), and 52.6% of BMI>40 kg/m(2), with significant lower %EWL in patients with BMI>40 kg/m(2) (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years. Conclusion: LSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m(2).
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Controversy Surrounding ‘Mini’ Gastric Bypass
Article
  • Feb 2014
Mini gastric bypass is a modification of Mason loop gastric bypass with a longer lesser curvature-based pouch. Though it has been around for more than 15 years, its uptake by the bariatric community has been relatively slow, and the procedure has been mired in controversy right from its early days. Lately, there seems to be a surge in the interest in this procedure, and there is now published experience with more than 5,000 procedures globally. This review examines the major controversial aspects of this procedure against the available scientific literature. Surgeons performing this procedure need to be aware of these controversies and counsel their patients appropriately.
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