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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.
Please
cite
this
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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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.
References
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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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... Obesity has been recognized as a global epidemic for more than 20 years, although records of procedures associated with obesity date back to medieval times [1]. Since Dr. Kremen's report of the first surgical procedure in 1954, bariatric surgery has demonstrated effectiveness and provided new insights into this disease [1,2]. ...
... Obesity has been recognized as a global epidemic for more than 20 years, although records of procedures associated with obesity date back to medieval times [1]. Since Dr. Kremen's report of the first surgical procedure in 1954, bariatric surgery has demonstrated effectiveness and provided new insights into this disease [1,2]. Over time, new, safer, and more effective techniques were developed, especially with the introduction of laparoscopy. ...
... The procedure was performed under general anesthesia. The patient was placed in the French position with 1 2 1 1 1 the surgeon standing in front of her, assisted by two assistants, one on the left and one on the right. Using the Veress technique, pneumoperitoneum was established at 15 mmHg at Palmer's point. ...
Article
Full-text available
Obesity has long been recognized as a global epidemic. One of the most effective treatments is bariatric surgery. Since the first modern procedure was reported, it has evolved over time, and multiple techniques have emerged. More than 20 years ago, one of the most widely used techniques was the non-adjustable gastric band (NAGB), which showed very promising short-term results. However, over time, it became apparent that it was not as effective in the long term. Associated gastrointestinal symptoms, such as reflux and constant vomiting, along with considerable weight regain, caused this technique to fall out of favor and be replaced by other procedures like the gastric sleeve (GS). Although the technique has fallen into disuse and is no longer recommended in the literature, there are still patients with associated complications. Few recent cases associated with these complications have been reported. Most undergo band removal, and whether to perform another procedure remains with limited evidence. We present the case of a patient who underwent an NAGB procedure 10 years ago and later experienced symptoms (reflux) and weight regain. She successfully underwent band removal and conversion to a GS at our institute in Mexico.
... The first modern bariatric surgery was reported in 1954 when Kremen performed jejuno-ileal bypass to treat obesity. It took further four decades until 1994, when the first laparoscopic gastric bypass was performed by Alan Wittgrove (Faria 2017).Bariatric surgery including laparoscopic sleeve gastrectomy (LSG) has been refined over the course of years making these operations safe, with low complication rates (Faria 2017). Bariatric proceduresare performed utilizing minimally invasive surgical techniques such as laparoscopic and robotic surgery that allows patients to have a better overall experience with less pain, fewer complications, shorter hospital stays and a faster recovery (King et al. 2020). ...
... The first modern bariatric surgery was reported in 1954 when Kremen performed jejuno-ileal bypass to treat obesity. It took further four decades until 1994, when the first laparoscopic gastric bypass was performed by Alan Wittgrove (Faria 2017).Bariatric surgery including laparoscopic sleeve gastrectomy (LSG) has been refined over the course of years making these operations safe, with low complication rates (Faria 2017). Bariatric proceduresare performed utilizing minimally invasive surgical techniques such as laparoscopic and robotic surgery that allows patients to have a better overall experience with less pain, fewer complications, shorter hospital stays and a faster recovery (King et al. 2020). ...
Article
Full-text available
Introduction The last few decades have witnessed exceptional growth in surgical innovation leading to the evolution of conventional gastro-intestinal surgery, and the birth of minimally invasive surgery. Aim A prospective longitudinal study was conducted to compare the safety, efficacy, and cost of three commonly used energy-based surgical vessel sealing devices in patients undergoing laparoscopic sleeve gastrectomy. Material and Methods 254 consecutive patients who underwent laparoscopic sleeve gastrectomy to treat obesity were included in the study. Time to clear the greater curvature of the stomach, total operative time, intra-operative complications including bleeding, length of hospital stay, 30-day postoperative complications, and overall procedure costs were compared according to the energy device used. Results Clearing the greater curvature of the stomach using Harmonic® was the fastest, taking only 13.6 minutes. However, there was no statistically significant difference in overall procedure duration or length of hospital stay for the three devices. No deaths occurred in this study. The quantity of intra-operative blood loss was least in the LigaSure™ group (45.6 ml). There was no statistically significant difference in the number of patients who had Intra-operative complications or those who had 30-day postoperative complications. Conclusion All devices were safe and effective energy devices when used in laparoscopic sleeve gastrectomy allowing for operative time reduction with minimal blood loss. The device type had no effect on the development of intra-operative or postoperative complications. The device type also had no impact on the overall procedure cost. Therefore, the device selection should depend on the surgeon's personal preference and local hospital resources.
... The history of bariatric surgery dates back to the 1950s, when jejunoileal bypass was first introduced as a weight-loss procedure. However, due to significant complications and adverse effects, this approach was mainly abandoned [3]. The subsequent development of gastric bypass, pioneered by Dr. Edward E. Mason in the 1960s, marked a significant advancement in the field. ...
... Since then, bariatric surgery has evolved with various procedures such as vertical banded gastroplasty, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with a duodenal switch. These procedures have demonstrated substantial improvements in weight loss and the resolution of obesity-related comorbidities [3]. ...
Article
Full-text available
Obesity is a global epidemic associated with an increased risk of severe health conditions such as type 2 diabetes, cardiovascular diseases, and certain cancers. Bariatric surgery has become a pivotal treatment for severe obesity, offering significant improvements in weight loss and comorbidity resolution. This comprehensive review aims to assess the long-term effectiveness and outcomes of various bariatric surgical procedures, highlighting current evidence and emerging trends in the field. We extensively reviewed the literature, including randomized controlled trials, cohort studies, and meta-analyses, to evaluate long-term weight loss, resolution of obesity-related comorbidities, quality of life (QoL), and complications associated with different bariatric procedures. Bariatric surgery has demonstrated substantial and sustained weight loss over the long term, with varying degrees of effectiveness among different procedures. Gastric bypass and sleeve gastrectomy are associated with significant improvements in comorbidities such as type 2 diabetes and hypertension. QoL outcomes are generally positive, improving physical health, mental well-being, and social functioning. However, long-term complications, including nutritional deficiencies and the need for reoperations, remain challenges. Emerging trends such as minimally invasive techniques and nonsurgical interventions show promise in enhancing patient outcomes. Bariatric surgery remains a highly effective intervention for managing severe obesity and its related health issues. While long-term outcomes are generally favorable, continued advancements in surgical techniques and postoperative care are crucial for optimizing results and minimizing complications. Future research should focus on personalized approaches to patient management and the development of novel treatment modalities to further improve outcomes in the long term.
... SG, a restrictive MBS, has evolved over the years to become a stand-alone and very common procedure [12]. The popularity of SG could be related to its safety profile when compared to other MBSs [13]. ...
Article
Full-text available
Background—Gastroesophageal reflux disease (GERD) is commonly diagnosed in patients with severe obesity. The outcomes of patients with preoperative GERD after sleeve gastrectomy (SG) are unclear, and some surgeons consider GERD a contraindication for SG. Methods—A retrospective analysis of a tertiary university hospital database was conducted. All patients with preoperative GERD undergoing SG between January 2012 and January 2020 and having at least two years of follow-up were included in the analysis. A validated GERD-associated quality of life questionnaire (GERD-HRQL) was completed by all patients. Results—During the study period, 116/1985 patients (5.8%) were diagnosed with GERD before SG. In total, 55 patients were available for a two-year follow-up and were included in the analysis. Median follow-up was 40 months (range 24–156 months). Mean total weight loss (TWL) was 24.0% ± 12.0%. On follow-up, 43 patients (78.1%) reported having GERD symptoms. In patients who underwent postoperative endoscopy, less than a third had esophagitis. The mean GERD-HRQL score was 25.2 ± 10.9. On univariable analysis, patients with poor GERD-HRQL had lower BMI at baseline (41.5 ± 12.4 vs. 44.9 ± 10.0 kg/m², p = 0.03), were less commonly smokers at baseline (8.1% vs. 33.3%, p = 0.02), and had lower TWL at the end of the follow-up (22.2% ± 10.4% vs. 28.9% ± 13.7%, p = 0.05). On multivariable analysis, smoking status at baseline and TWL at last follow-up were independent predictors of better GERD-HRQL. Conclusions—In conclusion, most GERD patients after SG have a relatively high GERD-HRQL score, most patients still have GERD symptoms during the follow-up, and approximately a third of patients have endoscopic signs of esophagitis. There was an association between patients with higher TWL and smoking at baseline and better GERD-HRQL outcomes. The latter is potentially due to smoking cessation.
... Therapeutic options include behavioral and lifestyle modifications, medical management, and surgical management via metabolic and bariatric surgery (MBS). Initially focused on restricting food intake or bypassing specific sections of the small bowel, early MBS procedures, such as the jejunoileal bypass, faced important challenges, including high rates of liver failure and other complications [4]. In 1960, Dr. Edward Mason introduced the gastric bypass, marking a significant advancement in MBS, with reduced complication rates and improved patient outcomes. ...
Article
Full-text available
Background: The field of metabolic and bariatric surgery (MBS) is currently an expanding surgical field with constant refinements in techniques, outcomes, indications, and objectives. MBS has been effectively applied across diverse patient demographics, including varying ages, genders, body mass indexes, and comorbidity statuses. Methods: We performed a comprehensive literature review of published retrospective cohort studies, meta-analyses, systematic reviews, and literature reviews from inception to 2024, reporting outcomes of MBS using databases such as PubMed, Sci-enceDirect, and Springer Link. Results: MBS is a safe and efficient therapeutic option for patients with obesity and associated medical conditions (mortality rate 0.03-0.2%; complication rates 0.4-1%). The favorable safety profile of MBS in the short-, mid-, and long-term offers the potential to treat patients with obesity and type 2 diabetes mellitus, immunosuppression, chronic anticoagula-tion, neoplastic disease, and end-organ failure without increased morbidity and mortality. Conclusions: In conclusion, the future of MBS lies in the ongoing innovation and adapted therapeutic strategies along with the integration of a variety of other techniques for managing obesity. Careful pre-operative assessments, coupled with a multidisciplinary approach, remain essential to ensure optimal surgical outcomes and patient satisfaction after MBS.
... Bariatric surgery has evolved since 1954 when its first documented instance was carried out by Kremen [8]. Especially in the 1990s, when obesity was acknowledged as a global epidemic by the World Health Organization and laparoscopic surgery entered its golden age, this development accelerated even further [9,10]. ...
... It has been a life-changing experience for thousands of people suffering from obesity worldwide. 36 Currently, MBS is indicated as the first-line treatment option for patients with class III obesity and patients with class II obesity along with metabolic complications that are expected to improve with weight loss. Also, it is considered in patients with class I obesity and type 2 diabetes and/or arterial hypertension with poor control despite optimal medical therapy based on evidence of randomized controlled trials and subsequent meta-analysis. ...
... SG has gained popularity because of its low morbidity and mortality rate, significant weight loss, and the ease of conversion to other, more extensive surgeries in the case of insufficient efficacy and reversibility [38,39]. While the original proposed mechanism behind this operation was pure restriction, it has become clear that the underlying mechanisms are more complex and include endocrine and neural mechanisms [26,40]. ...
Article
Full-text available
A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.
Article
Full-text available
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.
Article
Full-text available
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.
Article
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
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.
Article
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.
Article
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.
Article
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).
Article
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.